心力衰竭成人跌倒的频率和预测因素：一项前瞻性研究。
Frequency and Predictors of Falls Among Adults With Heart Failure: A Prospective Study.
机构信息
Oregon Health & Science University, School of Nursing, Portland, OR, USA; Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, USA.
Portland Veteran's Affairs Hospital, Portland, OR, USA; Oregon Health & Science University, Department of Medicine, Portland, OR, USA.
出版信息
J Card Fail. 2023 Mar;29(3):414-418. doi: 10.1016/j.cardfail.2022.09.011. Epub 2022 Oct 12.
OBJECTIVE
Adults with heart failure (HF) may be at high risk for falling due to age, comorbidities and frailty; however, few studies have examined falls in HF. The purpose of this study was to quantify the frequency and predictors of falls over 1 year among adults with HF.
METHODS
We conducted a prospective study of adults with New York Heart Association (NYHA) functional class I-IV HF. After baseline assessment of physical frailty and clinical characteristics, participants self-reported falls every 3 months during 1 year. Comparative statistics were used to identify baseline differences between those who fell vs those who did not. A stepwise negative binomial regression model was used to identify predictors of fall rate over 1 year.
RESULTS
The sample (n = 111) was 63.4 ± 15.7 years old, 48% were women, 28% had HF with preserved ejection fraction, and 41% were frail. Over 1 year, 43 (39%) of participants reported at least 1 fall and 28 (25%) of participants reported 2+ falls. Among those who fell, 29 (67%) reported injurious falls. Those who fell had significantly higher body mass indexes and were more likely to have NYHA class III/IV, type 2 diabetes and HF with preserved ejection fraction and to meet slowness and physical exhaustion criteria than those who did not fall. The fall rate was elevated among those with type 2 diabetes and those meeting the slowness and physical exhaustion criteria for physical frailty.
CONCLUSIONS
Nearly 40% of adults with HF experienced a fall within 1 year. Screening for comorbidities, slowness and exhaustion may help to identify those at risk for a fall.
目的
由于年龄、合并症和虚弱，心力衰竭（HF）的成年人可能有较高的跌倒风险；然而，很少有研究调查 HF 患者的跌倒情况。本研究的目的是量化 HF 成年人在 1 年内跌倒的频率和预测因素。
方法
我们对纽约心脏协会（NYHA）功能分级 I-IV 级 HF 的成年人进行了前瞻性研究。在进行身体虚弱和临床特征的基线评估后，参与者在 1 年内每 3 个月报告 1 次跌倒情况。使用比较统计学方法来识别跌倒者和未跌倒者之间的基线差异。使用逐步负二项回归模型来确定 1 年内跌倒率的预测因素。
结果
样本（n=111）的年龄为 63.4±15.7 岁，48%为女性，28%为射血分数保留型 HF，41%为虚弱。在 1 年内，43（39%）名参与者报告至少发生 1 次跌倒，28（25%）名参与者报告发生 2 次及以上跌倒。在跌倒的参与者中，29（67%）报告有受伤的跌倒。与未跌倒者相比，跌倒者的体重指数明显更高，NYHA 分级 III/IV、2 型糖尿病、射血分数保留型 HF 更常见，并且符合缓慢和体力衰竭标准。2 型糖尿病和符合体力虚弱缓慢和体力衰竭标准的患者跌倒率较高。
结论
近 40%的 HF 成年人在 1 年内发生跌倒。对合并症、缓慢和疲劳进行筛查可能有助于识别有跌倒风险的患者。
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