Department of Cardiology, Nishiarai Heart Center Hospital, 1-12-8 Nishiarai-Honcho, Adachi-ku, Tokyo, 123-0845, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
ESC Heart Fail. 2023 Jun;10(3):1698-1705. doi: 10.1002/ehf2.14114. Epub 2023 Feb 23.
Frailty is highly prevalent and associated with poor prognoses in elderly patients with heart failure (HF). However, the potential effects of physical frailty on the benefits of HF medications in elderly patients with HF are unclear. We aimed to determine the influence of physical frailty on the prognosis of HF medications in elderly patients with HF with reduced and mildly reduced ejection fraction (HFr/mrEF).
From the combined HF database of the FRAGILE-HF and Kitasato cohorts, hospitalized HF patients with a left ventricular ejection fraction < 50% and age ≥ 65 years were analysed. Patients treated with or without renin-angiotensin-aldosterone system inhibitors (RAASi) and beta-blockers at discharge were compared. Physical frailty was defined by the presence of ≥3 items on the Japanese version of the Cardiovascular Health Study criteria. The primary endpoint was all-cause mortality rate. Among the 1021 enrolled patients, 604 patients (59%) received both RAASi and beta-blockers, and 604 patients (59%) were diagnosed as physically frail. Patients receiving both RAASi and beta-blockers showed a significantly lower 1 year mortality than those not receiving either, even after adjusting for covariates (hazard ratio: 0.50, 95% confidence interval: 0.34-0.75). This beneficial effect of both medications on 1 year mortality was comparable between patients with and without physical frailty (hazard ratio: 0.53 and 0.51, respectively; P for interaction = 0.77).
The presence of physical frailty did not interact with the beneficial prognostic impact of RAASi and beta-blocker combination therapy in elderly patients with HFr/mrEF.
衰弱在老年射血分数降低型心力衰竭（HF）患者中非常普遍，并与预后不良相关。然而，身体衰弱对 HF 药物在老年 HF 患者中的疗效的潜在影响尚不清楚。我们旨在确定身体衰弱对射血分数降低和轻度降低的 HF（HFr/mrEF）老年患者 HF 药物预后的影响。
从 FRAGILE-HF 和桂由美队列的合并 HF 数据库中，分析了左心室射血分数<50%且年龄≥65 岁的住院 HF 患者。比较了出院时接受或不接受肾素-血管紧张素-醛固酮系统抑制剂（RAASi）和β受体阻滞剂治疗的患者。身体衰弱通过日本心血管健康研究标准的≥3 项存在来定义。主要终点是全因死亡率。在纳入的 1021 例患者中，604 例（59%）患者同时接受 RAASi 和β受体阻滞剂治疗，604 例（59%）患者被诊断为身体虚弱。即使在调整了协变量后，接受 RAASi 和β受体阻滞剂治疗的患者 1 年死亡率显著低于未接受任何一种药物治疗的患者（风险比：0.50，95%置信区间：0.34-0.75）。这两种药物对 1 年死亡率的有益影响在身体虚弱和无身体虚弱的患者之间是相当的（风险比：0.53 和 0.51，分别；P 交互=0.77）。
身体衰弱的存在与 RAASi 和β受体阻滞剂联合治疗对 HFr/mrEF 老年患者的有益预后影响没有相互作用。
