Yokota Junichi, Takahashi Ren, Chiba Takaaki, Matsukawa Yuko, Matsushima Keisuke, Sasaki Kosuke
Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, Hirosaki, 036-8564, Japan.
Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan.
Heart Vessels. 2023 Jan;38(1):66-76. doi: 10.1007/s00380-022-02133-9. Epub 2022 Jul 13.
This study aims to identify the relationship between dysphagia and developing hospital-acquired disability (HAD) in older patients with heart failure (HF). This single-center retrospective cohort study included 360 patients (median age, 84 years: 58.1% female, 41.9% male) who had undergone rehabilitation and were aged 65 years and older. Patients were divided into dysphagia and non-dysphagia groups and compared based on the Functional Oral Intake Scale score. HAD was defined as a decline in the Barthel Index score (indication of daily activity levels) at discharge relative to that before admission. The relationship between dysphagia and HAD was analyzed using bivariate analysis after adjusting for age, sex, body mass index, medical history, clinical and laboratory data, short physical performance battery (SPPB), and cognitive function at the start of rehabilitation, using propensity score matching. HAD was observed in 38.1% of the patients. Patients with dysphagia were significantly older, and had lower body mass index and physical and cognitive function than those without. After propensity score matching, the prevalence of HAD was significantly higher in the dysphagia group than in the non-dysphagia group (61.9% vs. 42.9%, P = 0.032). Dysphagia at the start of rehabilitation was an independent predictor of HAD. The results of this study may contribute to risk stratification of HAD.
本研究旨在确定老年心力衰竭(HF)患者吞咽困难与发生医院获得性残疾(HAD)之间的关系。这项单中心回顾性队列研究纳入了360例接受康复治疗且年龄在65岁及以上的患者(中位年龄84岁:女性占58.1%,男性占41.9%)。患者被分为吞咽困难组和非吞咽困难组,并根据功能性口服摄入量量表评分进行比较。HAD被定义为出院时Barthel指数评分(日常活动水平指标)相对于入院前下降。在对年龄、性别、体重指数、病史、临床和实验室数据、简短体能状况量表(SPPB)以及康复开始时的认知功能进行调整后,使用倾向评分匹配法对吞咽困难与HAD之间的关系进行双变量分析。38.1%的患者出现了HAD。吞咽困难患者的年龄显著更大,体重指数以及身体和认知功能均低于无吞咽困难的患者。倾向评分匹配后,吞咽困难组HAD的患病率显著高于非吞咽困难组(61.9%对42.9%,P = 0.032)。康复开始时的吞咽困难是HAD的独立预测因素。本研究结果可能有助于HAD的风险分层。