衰弱住院患者心力衰竭特异性药物治疗的获益：一项横断面研究。

Benefits of heart failure-specific pharmacotherapy in frail hospitalised patients: a cross-sectional study.

机构信息

College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

Department of General Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.

出版信息

BMJ Open. 2022 Sep 19;12(9):e059905. doi: 10.1136/bmjopen-2021-059905.

DOI:10.1136/bmjopen-2021-059905

PMID:36123054

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9486223/

Abstract

OBJECTIVES

Up to 50% of heart failure (HF) patients may be frail and have worse clinical outcomes than non-frail patients. The benefits of HF-specific pharmacotherapy (beta-blockers, ACE-inhibitors/angiotensin-receptor-blockers and mineralocorticoid-receptor-antagonist) in this population are unclear. This study explored whether HF-specific pharmacotherapy improves outcomes in frail hospitalised HF patients.

DESIGN

Observational, multicentre, cross-sectional study.

SETTINGS

Tertiary care hospitals.

PARTICIPANTS

One thousand four hundred and six hospitalised frail HF patients admitted between 1 January 2013 and 31 December 2020.

MEASURES

The Hospital Frailty Risk Score (HFRS) determined frailty status and patients with HFRS ≥5 were classified as frail. The primary outcomes included the days alive and out of hospital (DAOH) at 90 days following discharge, 30-day and 180-day mortality, length of hospital stay (LOS) and 30-day readmissions. Propensity score matching (PSM) compared clinical outcomes depending on the receipt of HF-specific pharmacotherapy.

RESULTS

Of 5734 HF patients admitted over a period of 8 years, 1406 (24.5%) were identified as frail according to the HFRS and were included in this study. Of 1406 frail HF patients, 1025 (72.9%) received HF-specific pharmacotherapy compared with 381 (27.1%) who did not receive any of these medications. Frail HF patients who did not receive HF-specific pharmacotherapy were significantly older, with higher creatinine and brain natriuretic peptide but with lower haemoglobin and albumin levels (p<0.05) when compared with those frail patients who received HF medications. After PSM frail patients on treatment were more likely to have an increased DAOH (coefficient 16.18, 95% CI 6.32 to 26.04, p=0.001) than those who were not on treatment. Both 30-day (OR 0.30, 95% CI 0.23 to 0.39, p<0.001) and 180-day mortality (OR 0.43, 95% CI 0.33 to 0.54, p<0.001) were significantly lower in frail patients on HF treatment but, there were no significant differences in LOS and 30-day readmissions (p>0.05).

CONCLUSION

This study found an association between the use of HF-specific pharmacotherapy and improved clinical outcomes in frail HF hospitalised patients when compared to those who were not on treatment.

TRIAL REGISTRATION NUMBER

ANZCTRN383195.

摘要

目的

多达 50%的心衰（HF）患者可能身体虚弱，临床结局比非虚弱患者差。HF 特异性药物治疗（β受体阻滞剂、ACEI/ARB 和盐皮质激素受体拮抗剂）对该人群的益处尚不清楚。本研究旨在探讨 HF 特异性药物治疗是否改善虚弱住院 HF 患者的结局。

设计

观察性、多中心、横断面研究。

地点

三级护理医院。

参与者

2013 年 1 月 1 日至 2020 年 12 月 31 日期间收治的 1406 名虚弱住院 HF 患者。

措施

采用医院衰弱风险评分（HFRS）确定衰弱状态，HFRS≥5 分的患者被归类为衰弱。主要结局包括出院后 90 天的存活天数和院外天数（DAOH）、30 天和 180 天死亡率、住院时间（LOS）和 30 天再入院率。采用倾向评分匹配（PSM）比较接受 HF 特异性药物治疗和未接受治疗的患者的临床结局。

结果

在 8 年期间，5734 名 HF 患者中，根据 HFRS 确定 1406 名（24.5%）为虚弱患者，并纳入本研究。在 1406 名虚弱 HF 患者中，1025 名（72.9%）接受了 HF 特异性药物治疗，381 名（27.1%）未接受任何此类药物治疗。与接受 HF 药物治疗的患者相比，未接受 HF 特异性药物治疗的虚弱 HF 患者年龄更大，肌酐和脑钠肽水平更高，但血红蛋白和白蛋白水平更低（p<0.05）。PSM 后，接受治疗的虚弱患者的 DAOH 增加（系数 16.18，95%CI 6.32 至 26.04，p=0.001）的可能性高于未接受治疗的患者。与未接受治疗的患者相比，30 天（OR 0.30，95%CI 0.23 至 0.39，p<0.001）和 180 天死亡率（OR 0.43，95%CI 0.33 至 0.54，p<0.001）均显著降低，但 LOS 和 30 天再入院率（p>0.05）无显著差异。