Peking University Fifth School of Clinical Medicine, Beijing, China, 100730.
Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730.
ESC Heart Fail. 2023 Apr;10(2):1133-1143. doi: 10.1002/ehf2.14274. Epub 2023 Jan 4.
Frailty in older patients with stage B heart failure with preserved ejection fraction (HFpEF) has not been fully explored. We evaluated the prevalence and prognostic significance of frailty in older patients diagnosed with stage B HFpEF.
Our prospective cohort study included inpatients aged ≥65 years who were followed up for 3 years. Stage B HFpEF was defined as cardiac structural or functional abnormalities with a left ventricular ejection fraction (LVEF) ≥ 50% without signs or symptoms. Frailty was assessed using the Fried phenotype. The primary outcome was 3-year all-cause mortality or readmission.
Overall, 520 older inpatients diagnosed with stage B HFpEF [mean ± standard deviation age: 75.5 ± 6.25 years, male: 222 (42.7%)] were included in the study. Of these, 145 (27.9%) were frail. Frail patients were older (78.5 ± 6.23 vs. 74.3 ± 6.22 years, P < 0.001), with a lower body mass index (24.6 ± 3.60 vs. 25.7 ± 3.27 kg/m , P = 0.001), higher level of N-terminal pro-B-type natriuretic peptide [279 (interquartile range: 112.4, 596) vs. 140 (67.1, 266) pg/mL, P < 0.001], longer timed up-and-go test result (19.9 ± 9.71 vs. 13.3 ± 5.08 s, P < 0.001), and poorer performance in the short physical performance battery (4.1 ± 3.26 vs. 8.2 ± 2.62, P < 0.001), basic activities of daily living (BADL, 4.7 ± 1.71 vs. 5.7 ± 0.57, P < 0.001), and instrumental activities of daily living (IADL, 4.4 ± 2.73 vs. 7.4 ± 1.33, P < 0.001). Frail patients were more likely to have a Mini-Mental State Examination (MMSE) score <24 (55.9% vs. 28.8%, P < 0.001) and take more than five medications (64.1% vs. 47.2%, P = 0.001). Frail patients had a higher incidence of all-cause mortality or readmission (62.8% vs. 47.7%, P = 0.002), all-cause readmission (56.6% vs. 45.9%, P = 0.029), and readmission for non-heart failure (55.2% vs. 41.3%, P = 0.004) during the 3-year follow-up, with a 1.53-fold (95%CI 1.11-2.11, P = 0.009) higher risk of all-cause mortality or readmission, a 1.52-fold (95%CI 1.09-2.11, P = 0.014) higher risk of all-cause readmission, and a 1.70-fold (95%CI 1.21-2.38, P = 0.002) higher risk of readmission for non-clinical heart failure, adjusted for sex, age, polypharmacy, Athens Insomnia Scale, MMSE, LVEF, BADL, and IADL.
Frailty is common in elderly patients with stage B HFpEF. Physical frailty, particularly low physical activity, can independently predict the long-term prognosis in these patients.
年龄较大的射血分数保留心力衰竭（HFpEF）患者的虚弱状态尚未得到充分探讨。我们评估了在诊断为心力衰竭 B 期的 HFpEF 较年长患者中虚弱的患病率和预后意义。
我们的前瞻性队列研究纳入了≥65 岁的住院患者，随访时间为 3 年。心力衰竭 B 期的定义为左心室射血分数（LVEF）≥50%，无心力衰竭体征或症状的心脏结构或功能异常。使用 Fried 表型评估虚弱。主要结局为 3 年全因死亡率或再入院。
总体而言，520 名被诊断为心力衰竭 B 期 HFpEF 的老年住院患者[平均年龄±标准差：75.5±6.25 岁，男性：222 名（42.7%）]被纳入研究。其中，145 名（27.9%）患者身体虚弱。虚弱患者年龄较大（78.5±6.23 岁 vs. 74.3±6.22 岁，P<0.001），体重指数较低（24.6±3.60 千克/平方米 vs. 25.7±3.27 千克/平方米，P=0.001），N 末端 B 型利钠肽前体[279（四分位距：112.4，596）比 140（67.1，266）pg/ml，P<0.001]较高，计时起立行走测试结果较长[19.9±9.71 秒 vs. 13.3±5.08 秒，P<0.001]，简易体能状况量表评分较低[4.1±3.26 分 vs. 8.2±2.62 分，P<0.001]，基本日常生活活动（BADL）较差[4.7±1.71 分 vs. 5.7±0.57 分，P<0.001]和工具性日常生活活动（IADL）较差[4.4±2.73 分 vs. 7.4±1.33 分，P<0.001]。虚弱患者更有可能存在简易精神状态检查（MMSE）评分<24（55.9%比 28.8%，P<0.001）和服用超过五种药物（64.1%比 47.2%，P=0.001）。虚弱患者的全因死亡率或再入院率较高（62.8%比 47.7%，P=0.002），全因再入院率较高（62.8%比 47.7%，P=0.002），非心力衰竭再入院率较高（55.2%比 41.3%，P=0.004），全因死亡率或再入院的风险增加 1.53 倍（95%可信区间：1.11-2.11，P=0.009），全因再入院的风险增加 1.52 倍（95%可信区间：1.09-2.11，P=0.014），非心力衰竭再入院的风险增加 1.70 倍（95%可信区间：1.21-2.38，P=0.002），调整性别、年龄、多药治疗、雅典失眠量表、MMSE、LVEF、BADL 和 IADL 后。
衰弱在年龄较大的射血分数保留心力衰竭 B 期患者中很常见。身体虚弱，特别是体力活动减少，可独立预测这些患者的长期预后。
