老年急性心力衰竭：临床特征与管理中与环境相关的差异

Acute heart failure in the elderly: setting related differences in clinical features and management.

作者信息

Orso Francesco, Pratesi Alessandra, Herbst Andrea, Baroncini Anna Chiara, Bacci Francesca, Ciuti Gabriele, Berni Andrea, Tozzetti Camilla, Nozzoli Carlo, Pignone Alberto Moggi, Poggesi Loredana, Gabbani Luciano, Bari Mauro Di, Fattirolli Francesco, Milli Massimo, Ungar Andrea, Marchionni Niccolò, Baldasseroni Samuele

机构信息

Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

出版信息

J Geriatr Cardiol. 2021 Jun 28;18(6):407-415. doi: 10.11909/j.issn.1671-5411.2021.06.003.

DOI:10.11909/j.issn.1671-5411.2021.06.003

PMID:34220970

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8220379/

Abstract

BACKGROUND

Administrative data show that acute heart failure (HF) patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care. The purpose of this study was to describe clinical characteristics of old patients hospitalised for acute HF in Cardiology, Internal Medicine or Geriatrics wards.

METHODS

Data came from ATHENA (AcuTe Heart failurE in advaNced Age) registry which included elderly patients (≥ 65 years) admitted to the above mentioned settings of care from December 1, 2014 to December 1, 2015.

RESULTS

We enrolled 396 patients, 15.4% assigned to Cardiology, 69.7% to Internal Medicine, and 14.9% to a Geriatrics ward. Mean age was 83.5 ± 7.6 years (51.8% of patients ≥ 85 years) and was higher in patients admitted to Geriatrics ( < 0.001); more than half were females. Medical treatments did not differ significantly among settings of care (in a context of a low prescription rate of renin-angiotensin-aldosterone system inhibitors) whereas significant differences were observed in comorbidity patterns and management guidelines recommendation adherence for decongestion evaluation with comparison of weight and N-terminal pro-B-type natriuretic peptide levels on admission and at discharge (both = 0.035 and < 0.001), echocardiographic evaluation ( < 0.001) and follow-up visits planning ( < 0.001), all higher in Cardiology. Mean in-hospital length of stay was 9 ± 5.9 days, significantly higher in Geriatrics (13.7 ± 6.5 days) and Cardiology (9.9 ± 6.7 days) compared to Internal Medicine (8 ± 5.2 days), < 0.001. In-hospital mortality was 9.3%, resulting higher in Geriatrics (18.6%) and Cardiology (16.4%) than Internal Medicine (5.8%), = 0.001.

CONCLUSIONS

In elderly patients hospitalised for acute HF, clinical characteristics and management differ significantly according to the setting of admission.

摘要

背景

管理数据显示，急性心力衰竭（HF）患者的年龄比临床登记中的患者更大，且经常入住非心脏科护理机构。本研究的目的是描述在心脏病科、内科或老年病科病房因急性HF住院的老年患者的临床特征。

方法

数据来自ATHENA（老年急性心力衰竭）登记处，该登记处纳入了2014年12月1日至2015年12月1日期间入住上述护理机构的老年患者（≥65岁）。

结果

我们纳入了396例患者，15.4%分配至心脏病科，69.7%分配至内科，14.9%分配至老年病科病房。平均年龄为83.5±7.6岁（51.8%的患者≥85岁），入住老年病科的患者年龄更高（<0.001）；超过一半为女性。在护理机构中，药物治疗无显著差异（肾素-血管紧张素-醛固酮系统抑制剂处方率较低），而在合并症模式以及充血评估的管理指南推荐依从性方面观察到显著差异，比较入院时和出院时的体重及N末端B型利钠肽原水平（P均=0.0 .035且<0.001）、超声心动图评估（<0.001）和随访计划（<0.001），这些在心脏病科均更高。平均住院时间为9±5.9天，与内科（8±5.2天）相比，老年病科（13.7±6.5天）和心脏病科（9.9±6.7天）显著更长，<0 .001。住院死亡率为9.3%，老年病科（18.6%）和心脏病科（16.4%）高于内科（5.8%），P=0.001。