心力衰竭患者的医院衰弱风险评分与结局密切相关，但与药物治疗的关系则不那么密切。

The hospital frailty risk score in patients with heart failure is strongly associated with outcomes but less so with pharmacotherapy.

机构信息

Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Canadian VIGOUR Centre, Faculty of Medicine and Dentissstry, University of Alberta, Edmonton, Canada.

出版信息

J Intern Med. 2020 Mar;287(3):322-332. doi: 10.1111/joim.13002. Epub 2019 Nov 14.

DOI:10.1111/joim.13002

PMID:31661589

Abstract

BACKGROUND

Although frailty is known to be an important prognostic factor in heart failure (HF), HF risk-adjustment models do not incorporate frailty measures and the interplay between frailty, age and pharmacotherapy is unclear.

OBJECTIVES

To explore the relationships between frailty, pharmacotherapy and outcomes in heart failure (HF).

METHODS

Retrospective cohort study of all adults in Alberta, Canada hospitalized for the first time for HF between 2004 and 2016. Frailty was defined using the Hospital Frailty Risk Score (HFRS).

RESULTS

In 26 626 patients (mean age 77.4 years), the 8887 (33.4%) defined as frail (HFRS ≥ 5) were older, had higher Charlson scores and more prior emergency department visits or hospitalizations. The HFRS and the Charlson Score were only weakly correlated (r = 0.35). Whilst more common in older patients (41.4% of patients 80 or older), frailty was present in 22.4% of patients younger than 65. Frail patients had longer lengths of stay and worse outcomes postdischarge, but adding the HFRS to age, sex and Charlson score did not improve prediction of events (c-statistics 0.69 for 30-day mortality after admission, and 0.54 for 30-day readmission/ED visit/or death after discharge). Frail patients younger than 65 were significantly more likely than nonfrail patients 80 or older to be prescribed high-dose evidence-based HF therapies (27.1% vs. 22.2%, P = 0.003).

CONCLUSION

Although the HFRS reflects aspects of frailty that patient age and Charlson scores do not, the addition of the HFRS to standard risk prediction equations provides little additional information. Prescribing practices correlate more with patient age than frailty status.

摘要

背景

尽管衰弱是心力衰竭（HF）的一个重要预后因素，但 HF 风险调整模型并未纳入衰弱指标，衰弱、年龄和药物治疗之间的相互作用也不清楚。

目的

探讨衰弱与心力衰竭（HF）患者的药物治疗和结局之间的关系。

方法

这是一项在 2004 年至 2016 年间因首次 HF 住院的加拿大艾伯塔省所有成年人的回顾性队列研究。使用医院衰弱风险评分（HFRS）来定义衰弱。

结果

在 26626 例患者（平均年龄 77.4 岁）中，8887 例（33.4%）被定义为衰弱（HFRS≥5），这些患者年龄更大，Charlson 评分更高，急诊就诊或住院次数更多。HFRS 和 Charlson 评分相关性仅为中度（r=0.35）。尽管衰弱在 80 岁以上患者中更为常见（41.4%），但在 65 岁以下患者中也存在 22.4%。衰弱患者的住院时间更长，出院后结局更差，但将 HFRS 与年龄、性别和 Charlson 评分相结合并不能提高对事件的预测能力（入院后 30 天死亡率的 C 统计量为 0.69，出院后 30 天再入院/急诊就诊/死亡的 C 统计量为 0.54）。年龄在 65 岁以下的衰弱患者比 80 岁或以上的非衰弱患者更有可能接受高剂量循证 HF 治疗（27.1%比 22.2%，P=0.003）。