Gohbara Masaomi, Nishimura Kunihiro, Nakai Michikazu, Sumita Yoko, Endo Tsutomu, Matsuzawa Yasushi, Konishi Masaaki, Kosuge Masami, Ebina Toshiaki, Tamura Kouichi, Kimura Kazuo
Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital Yokohama Japan.
Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center Suita Japan.
Circ Rep. 2018 Dec 14;1(1):20-28. doi: 10.1253/circrep.CR-18-0009.
The aim of this study was to clarify the clinical impact of activities of daily living (ADL) using the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database. From April 2012 to March 2014, the JROAD-DPC database included 206,643 patients with acute coronary syndrome (ACS; n=49,784), heart failure (HF; n=136,878), or aortic aneurysm/dissection (Aorta; n=19,981). We divided them into 3 categories with regard to age (low, 20-59 years; middle, 60-79 years; high, ≥80 years) and admission ADL (low, Barthel index [BI] 0-70; middle, BI 75-95; high, BI 100). ACS, HF, and Aorta patients with low ADL had higher in-hospital mortality rates (18.3%, 16.7%, and 33.4%) than those with middle or high ADL (P<0.001, χ test). On multivariable analysis, BI on admission was associated with in-hospital mortality of ACS (OR, 0.986 per 1 BI; P<0.001), HF (OR, 0.986 per 1 BI; P<0.001), and Aorta (OR, 0.986 per 1 BI; P<0.001), adjusted for gender, age, body mass index, hypertension, diabetes mellitus, dyslipidemia, and the Charlson comorbidity index. Moreover, patients with low age and low ADL had a higher in-hospital mortality rate than those with high age and high ADL in regard to HF (8.6% vs. 6.0%). According to JROAD-DPC data, assessment of admission ADL is important in patients with cardiovascular disease.
本研究旨在利用日本全心脏和血管疾病诊断程序组合登记处（JROAD-DPC）数据库阐明日常生活活动（ADL）的临床影响。2012年4月至2014年3月，JROAD-DPC数据库纳入了206,643例急性冠状动脉综合征（ACS；n = 49,784）、心力衰竭（HF；n = 136,878）或主动脉瘤/夹层（主动脉；n = 19,981）患者。我们根据年龄（低龄，20 - 59岁；中年，60 - 79岁；高龄，≥80岁）和入院时的ADL（低，Barthel指数[BI] 0 - 70；中，BI 75 - 95；高，BI 100）将他们分为3类。ADL低的ACS、HF和主动脉患者院内死亡率（分别为18.3%、16.7%和33.4%）高于ADL中等或高的患者（P<0.001，χ检验）。多变量分析显示，入院时的BI与ACS（每1个BI的OR为0.986；P<0.001）、HF（每1个BI的OR为0.986；P<0.001）和主动脉（每1个BI的OR为0.986；P<0.001）的院内死亡率相关，并对性别、年龄、体重指数、高血压、糖尿病、血脂异常和Charlson合并症指数进行了校正。此外，就HF而言，低龄且ADL低的患者院内死亡率高于高龄且ADL高的患者（8.6%对6.0%）。根据JROAD-DPC数据，入院时ADL的评估对心血管疾病患者很重要。
