Wang Weijia, Lessard Darleen, Saczynski Jane S, Goldberg Robert J, Mehawej Jordy, Gracia Ely, McManus David D
Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Int J Cardiol Heart Vasc. 2021 Mar 4;33:100739. doi: 10.1016/j.ijcha.2021.100739. eCollection 2021 Apr.
Geriatric conditions, such as frailty and cognitive impairment, are prevalent in older patients with atrial fibrillation (AF). We examined the prognostic value of geriatric conditions for predicting 1-year mortality and bleeding events in these patients.
SAGE (Systematic Assessment of Geriatric Elements)-AF study is a multicenter cohort study which enrolled individuals (mean age 75 years, 48% women, 86% taking oral anticoagulation) 65 years and older with AF and CHADS -VASc score of 2 or higher from clinics in Massachusetts and Georgia, USA between 2016 and 2018. A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing was performed at baseline. Study endpoints included all-cause mortality and clinically relevant bleeding.
At 1 year, 1,097 (96.5%) individuals attended the follow up visit, 44 (3.9%) had died, and 56 (5.1%) had clinically relevant bleeding. After adjustment for demographic and clinical factors, social isolation (odds ratio [OR] 1.69, 95% confidence interval [CI]: 1.01-2.84), depression (OR 1.94, 95% CI: 1.28-2.95) and frailty (OR 2.55, 95% CI: 1.55-4.19) were significantly associated with the composite endpoint of death or clinically relevant bleeding. After multivariable adjustment, depression (OR 1.79, 95% CI 1.09-2.93) and frailty (OR 2.83, 95% CI 1.55-5.17) were significantly associated with clinically relevant bleeding.
Social isolation, depression, and frailty were prognostic of dying or experiencing clinically relevant bleeding during the coming year in older men and women with AF. Assessing geriatric impairments merits consideration in the care of these patients.
老年疾病，如衰弱和认知障碍，在老年房颤（AF）患者中很常见。我们研究了老年疾病对预测这些患者1年死亡率和出血事件的预后价值。
SAGE（老年因素系统评估）-AF研究是一项多中心队列研究，纳入了2016年至2018年期间来自美国马萨诸塞州和佐治亚州诊所的65岁及以上患有房颤且CHADS-VASc评分为2或更高的个体（平均年龄75岁，48%为女性，86%接受口服抗凝治疗）。在基线时进行了包括衰弱、认知功能、社会支持、抑郁症状、视力和听力的有效测量在内的六组分老年评估。研究终点包括全因死亡率和临床相关出血。
1年后，1097名（96.5%）个体参加了随访，44名（3.9%）死亡，56名（5.1%）发生临床相关出血。在调整人口统计学和临床因素后，社会孤立（比值比[OR]1.69，95%置信区间[CI]：1.01-2.84）、抑郁（OR 1.94，95%CI：1.28-2.95）和衰弱（OR 2.55，95%CI：1.55-4.19）与死亡或临床相关出血的复合终点显著相关。经过多变量调整后，抑郁（OR 1.79，95%CI 1.09-2.93）和衰弱（OR 2.83，95%CI 1.55-5.17）与临床相关出血显著相关。
社会孤立、抑郁和衰弱是老年房颤男女患者在未来一年内死亡或发生临床相关出血的预后指标。在这些患者的护理中，评估老年损伤值得考虑。
