Méndez-Bailon Manuel, Lorenzo-Villalba Noel, Rubio-Garcia Jorge, Moreno-García María Carmen, Ropero-Luis Guillermo, Martínez-Litago Eduardo, Quirós-López Raúl, Carrascosa-García Sara, González-Franco Alvaro, Andrès Emmanuel, Casado-Cerrada Jesús, Montero-Pérez-Barquero Manuel
Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Universidad Complutense, 28040 Madrid, Spain.
Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
J Clin Med. 2022 Jun 18;11(12):3516. doi: 10.3390/jcm11123516.
Background: Patients with heart failure encompass a heterogeneous group, but they are mostly elderly patients with a large burden of comorbid conditions. Objective: The aim of this study was to compare the clinical characteristics and the prognostic impact on hospital admissions and mortality in a population of patients with HF with different types of caregivers (family members, professionals, and the patient himself). Methods: We conducted an observational study from a prospective registry. Patients from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. Patients with heart failure were classified, according to the type of main caregiver, into four groups: the patient himself/herself, a partner, children, or a professional caregiver. A bivariable analysis was performed between the clinical, analytical, therapeutic, and prognostic characteristics of the different groups. The endpoints of the study were all-cause mortality at 1 year; mortality at 120 days; and the readmission rate for HF at 30 days, 120 days, and 1 year of follow-up. In all cases, the level of statistical significance was set at p < 0.05. Results: A total of 2147 patients were enrolled in this study; women represented 52.4%, and the mean age was 81 years. The partner was the caregiver for 703 patients, children were caregivers for 1097 patients, 199 patients had a professional caregiver, and only 148 patients were their own caregivers. Women were more frequently cared for by their children (65.8%) or a professional caregiver (61.8%); men were more frequently cared for by their spouses (68.7%) and more frequently served as their own caregivers (59.5%) (p < 0.001). No statistically significant differences were observed in relation to readmissions or mortality at one year of follow-up between the different groups. A lower probability of readmission and death was observed for patients who received care from a partner or children/relative, with log-rank scores of 11.2 with p= 0.010 and 10.8 with p = 0.013. Conclusions: Our study showed that the presence of a family caregiver for elderly patients with heart failure was associated with a lower readmission rate and a lower mortality rate at 120 days of follow-up. Our study also demonstrated that elderly patients with good cognitive and functional status can be their own caregivers, as they obtained good health outcomes in terms of readmission and mortality. More prospective studies and clinical trials are needed to evaluate the impact of different types of caregivers on the outcomes of patients with heart failure.
心力衰竭患者群体异质性强，但大多为老年患者，合并症负担较重。目的：本研究旨在比较不同类型照料者（家庭成员、专业人员和患者本人）对心力衰竭患者群体的临床特征以及住院和死亡率的预后影响。方法：我们通过前瞻性登记进行了一项观察性研究。纳入了来自西班牙内科协会（SEMI）心力衰竭和心房颤动工作组的国家心力衰竭登记处（RICA）的患者。根据主要照料者类型，将心力衰竭患者分为四组：患者本人、伴侣、子女或专业照料者。对不同组的临床、分析、治疗和预后特征进行了双变量分析。研究终点为1年全因死亡率；120天死亡率；以及随访30天、120天和1年时心力衰竭再入院率。在所有情况下，统计学显著性水平设定为p<0.05。结果：本研究共纳入2147例患者；女性占52.4%，平均年龄为81岁。伴侣为703例患者的照料者，子女为1097例患者的照料者，199例患者有专业照料者，只有148例患者由自己照料。女性更多由子女（65.8%）或专业照料者（61.8%）照料；男性更多由配偶照料（68.7%），且更多作为自己的照料者（59.5%）（p<0.001）。不同组在随访一年时的再入院率或死亡率方面未观察到统计学显著差异。接受伴侣或子女/亲属照料的患者再入院和死亡概率较低，对数秩得分分别为11.2（p = 0.010）和10.8（p = 0.013）。结论：我们的研究表明，老年心力衰竭患者有家庭照料者与随访120天时较低的再入院率和死亡率相关。我们的研究还表明，认知和功能状态良好的老年患者可以自己照料，因为他们在再入院和死亡率方面获得了良好的健康结局。需要更多前瞻性研究和临床试验来评估不同类型照料者对心力衰竭患者结局的影响。
