Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Eur J Heart Fail. 2020 Nov;22(11):2112-2119. doi: 10.1002/ejhf.1926. Epub 2020 Jul 14.
To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure.
The FRAGILE-HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini-Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all-cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow-up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 [95% confidence interval (CI) 0.89-2.13; P = 0.15], 1.60 (95% CI 1.04-2.46; P = 0.034), and 2.04 (95% CI 1.28-3.24; P = 0.003), respectively. Incorporating the number of frailty domains into the pre-existing risk model yielded a 22.0% (95% CI 0.087-0.352; P = 0.001) net reclassification improvement for the primary outcome.
The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi-domain frailty provides additive value to known prognostic factors.
描述老年心力衰竭住院患者中身体和社会脆弱性以及认知功能障碍的流行率、重叠程度及其预后意义。
FRAGILE-HF 研究是一项前瞻性多中心队列研究，纳入了≥65 岁的连续心力衰竭住院患者。该研究的目的是研究多个脆弱领域共存的流行率、重叠程度及其预后意义。身体脆弱性、社会脆弱性和认知功能障碍分别采用 Fried 表型模型、Makizako 的 5 项指标和 Mini-Cog 进行评估。主要研究终点为心力衰竭再住院和 1 年内全因死亡的联合终点。在纳入的 1180 例住院患者中（中位年龄 81 岁，57.4%为男性），分别有 56.1%、66.4%和 37.1%的患者存在身体脆弱性、社会脆弱性和认知功能障碍。在患者中，分别有 13.5%、31.4%、36.9%和 18.2%的患者存在 0、1、2 和 3 个确定的脆弱领域。在随访期间，有 383 例患者发生了联合终点事件。与 0 个领域作为参考相比，1、2 和 3 个领域的调整后的风险比分别为 1.38（95%可信区间 0.89-2.13；P=0.15）、1.60（95%可信区间 1.04-2.46；P=0.034）和 2.04（95%可信区间 1.28-3.24；P=0.003）。将脆弱领域的数量纳入预先存在的风险模型中，可使主要结局的净重新分类改善率提高 22.0%（95%可信区间 0.087-0.352；P=0.001）。
老年心力衰竭住院患者中多个脆弱领域的共存很常见。对多领域脆弱性的综合评估为已知预后因素提供了附加价值。
