BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France.
Eur J Heart Fail. 2020 Nov;22(11):2123-2133. doi: 10.1002/ejhf.1832. Epub 2020 Apr 30.
Frailty, characterized by loss of homeostatic reserves and increased vulnerability to physiological decompensation, results from an aggregation of insults across multiple organ systems. Frailty can be quantified by counting the number of 'health deficits' across a range of domains. We assessed the frequency of, and outcomes related to, frailty in patients with heart failure and reduced ejection fraction (HFrEF).
Using a cumulative deficits approach, we constructed a 42-item frailty index (FI) and applied it to identify frail patients enrolled in two HFrEF trials (PARADIGM-HF and ATMOSPHERE). In keeping with previous studies, patients with FI ≤0.210 were classified as non-frail and those with higher scores were divided into two categories using score increments of 0.100. Clinical outcomes were examined, adjusting for prognostic variables. Among 13 625 participants, mean (± standard deviation) FI was 0.250 (0.10) and 8383 patients (63%) were frail (FI >0.210). The frailest patients were older and had more symptoms and signs of heart failure. Women were frailer than men. All outcomes were worse in the frailest, with high rates of all-cause death or all-cause hospitalization: 40.7 (39.1-42.4) vs. 22.1 (21.2-23.0) per 100 person-years in the non-frail; adjusted hazard ratio 1.63 (1.53-1.75) (P < 0.001). The rate of all-cause hospitalizations, taking account of recurrences, was 61.5 (59.8-63.1) vs. 31.2 (30.3-32.2) per 100 person-years (incidence rate ratio 1.76; 1.62-1.90; P < 0.001).
Frailty is highly prevalent in HFrEF and associated with greater deterioration in quality of life and higher risk of hospitalization and death. Strategies to prevent and treat frailty are needed in HFrEF.
衰弱是一种由多个器官系统受到多种损伤而导致的内稳态储备丧失和对生理失代偿易感性增加的综合征。衰弱可以通过计算一系列领域中的“健康缺陷”数量来量化。我们评估了射血分数降低的心力衰竭（HFrEF）患者中衰弱的发生频率及其与结局的相关性。
我们采用累积缺陷方法构建了 42 项衰弱指数（FI），并应用该指数识别了两项 HFrEF 试验（PARADIGM-HF 和 ATMOSPHERE）中纳入的衰弱患者。与既往研究一致，FI≤0.210 的患者被归类为非衰弱，而分数较高的患者则进一步分为两个类别，每个类别之间的分数增量为 0.100。在调整了预后变量后，我们检查了临床结局。在 13625 名参与者中，FI 的平均值（±标准差）为 0.250（0.10），8383 名患者（63%）为衰弱（FI＞0.210）。最衰弱的患者年龄更大，且具有更多心力衰竭的症状和体征。女性比男性更衰弱。所有结局在最衰弱的患者中均更差，全因死亡或全因住院的发生率很高：非衰弱患者为 40.7（39.1-42.4）/100 人年，而衰弱患者为 40.7（39.1-42.4）/100 人年；调整后的危险比为 1.63（1.53-1.75）（P＜0.001）。考虑到复发，全因住院的发生率为 61.5（59.8-63.1）/100 人年，而非衰弱患者为 31.2（30.3-32.2）/100 人年；发病率比为 1.76（1.62-1.90）（P＜0.001）。
衰弱在 HFrEF 中非常普遍，与生活质量恶化、住院和死亡风险增加相关。需要在 HFrEF 中制定预防和治疗衰弱的策略。
