Gastelurrutia Paloma, Lupón Josep, Moliner Pedro, Yang Xiaobo, Cediel German, de Antonio Marta, Domingo Mar, Altimir Salvador, González Beatriz, Rodríguez Margarita, Rivas Carmen, Díaz Violeta, Fung Erik, Zamora Elisabet, Santesmases Javier, Núñez Julio, Woo Jean, Bayes-Genis Antoni
ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.
Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.
Mayo Clin Proc Innov Qual Outcomes. 2018 Apr 19;2(2):176-185. doi: 10.1016/j.mayocpiqo.2018.02.004. eCollection 2018 Jun.
To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area.
Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed.
Comorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, <.001, and 36.5±20.7, =.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (=.09) nor HFpEF (54.3%) (=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (≤.001), and fragility was independently associated with all-cause death and the composite end point (<.001) in HFmrEF.
Comorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.
评估合并症、身体虚弱和生活质量（QOL）对中度左心室射血分数（HFmrEF）的门诊心力衰竭（HF）患者长期预后的影响，这是一个尚未探索的领域。
对2001年8月1日至2015年12月31日期间在一家HF诊所进行前瞻性评估的连续患者，根据左心室射血分数类别进行回顾性分析。我们将HFmrEF患者（n = 185）与射血分数降低（HFrEF；n = 1058）和保留（HFpEF；n = 162）的患者进行比较。身体虚弱定义为在4种标准化老年量表（Barthel指数、美国老年人资源与服务量表、Pfeiffer测试和简易老年抑郁量表）上有1项或更多异常评估。使用明尼苏达心力衰竭生活问卷评估生活质量。构建合并症评分（0 - 7）。评估全因死亡、HF相关住院以及两者的复合终点。
HFmrEF患者（分别为2.41±1.5和30.1±18.3）与HFrEF患者（分别为2.30±1.4和30.8±18.5）的合并症和QOL评分相似，而HFpEF患者的合并症和QOL评分更高（分别为3.02±1.5，<.001，和36.5±20.7，=.003）。未发现HFmrEF（48.6%）与HFrEF（41.9%）（P =.09）以及HFmrEF与HFpEF（54.3%）（P =.29）之间在身体虚弱方面有统计学显著差异。在单因素分析中，HFmrEF患者的合并症、QOL和身体虚弱与3个终点的关联高于HFrEF和HFpEF患者。在多因素分析中，合并症与3个终点独立相关（P≤.001），身体虚弱与HFmrEF患者的全因死亡和复合终点独立相关（P<.001）。
合并症和身体虚弱是门诊HFmrHF患者预后的独立预测因素，在HFmrEF的常规临床评估中应予以考虑。
