医院获得性残疾对老年心力衰竭患者的预后影响
Prognostic impact of hospital-acquired disability in elderly patients with heart failure.
作者信息
Saitoh Masakazu, Takahashi Yuta, Okamura Daisuke, Akiho Mitsutoshi, Suzuki Hidetoshi, Noguchi Naoki, Yamaguchi Yukito, Hori Kentaro, Adachi Yuichi, Takahashi Tetsuya
机构信息
Department of Physical Therapy, Faculty of Health Science, Juntendo University Tokyo, 3-2-12, Hongo, Bunkyo-ku, Ochanomizu Centre Building 503, Tokyo, 113-0033, Japan.
Department of Rehabilitation, Sakakibara Heart Institute, Tokyo, Japan.
出版信息
ESC Heart Fail. 2021 Jun;8(3):1767-1774. doi: 10.1002/ehf2.13356. Epub 2021 Apr 10.
AIMS
Functional decline is associated with worse outcomes in patients with elderly heart failure (HF), but little is known about the prognostic impact of hospital-acquired disability (HAD) during hospital stay after acute HF. The present study examines the prognostic significance of HAD in the prediction of all-cause mortality in elderly patients who admitted for acute HF.
METHODS AND RESULTS
This retrospective study was performed in 1941 elderly patients aged ≥65 years or older from the cardiovascular physiotherapy for acute HF patients in the Tokyo metropolitan area registry and excluded those who died in hospital. HAD was defined as any decline in the Barthel index (BI) before discharge compared with the BI within 1 month before hospital admission. The primary outcome of this study was all-cause death and HF readmission. A total of 565 (29%) deaths and 789 (41%) HF readmission occurred over a median follow-up period of 1.7 years. A total of 476 patients (25%) had HAD during hospital stay after acute HF. In multivariable analysis, HAD predicted all-cause death [hazard ratio (HR): 1.772; 95% confidence interval (CI): 1.450-2.167; P < 60; 0.001] and with risk of HF readmission (HR: 1.193; 95% CI: 1.005-1.416; P = 0.043) after adjusting for the Meta-analysis Global Group in Chronic Heart Failure risk score.
CONCLUSIONS
Hospital-acquired disability is associated with an increased risk of all-cause death and readmission for HF in elderly patients with acute HF.
目的
功能衰退与老年心力衰竭（HF）患者的不良预后相关，但对于急性HF患者住院期间发生的医院获得性残疾（HAD）的预后影响知之甚少。本研究探讨HAD在预测急性HF入院老年患者全因死亡率方面的预后意义。
方法和结果
本回顾性研究纳入了东京都市区急性HF患者心血管物理治疗登记处的1941例年龄≥65岁的老年患者，并排除了在医院死亡的患者。HAD定义为出院时Barthel指数（BI）较入院前1个月内的BI有所下降。本研究的主要结局是全因死亡和HF再入院。在中位随访期1.7年期间，共发生565例（29%）死亡和789例（41%）HF再入院。共有476例患者（25%）在急性HF后的住院期间发生了HAD。在多变量分析中，在调整慢性心力衰竭风险评分的Meta分析全球组后，HAD可预测全因死亡[风险比（HR）：1.772；95%置信区间（CI）：1.450 - 2.167；P < 0.001]以及HF再入院风险（HR：1.193；95% CI：1.005 - 1.416；P = 0.043）。
结论
医院获得性残疾与急性HF老年患者全因死亡和HF再入院风险增加相关。
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