Division of Experimental Medicine McGill University Montreal Quebec Canada.
Centre for Clinical Epidemiology Jewish General Hospital Montreal Quebec Canada.
J Am Heart Assoc. 2023 Mar 21;12(6):e026951. doi: 10.1161/JAHA.122.026951. Epub 2023 Mar 9.
Background Frailty is prevalent in older adults with heart failure and is associated with poor outcomes; however, there remains uncertainty on how to measure frailty in clinical practice. Methods and Results A multicentric prospective cohort study was assembled at 4 heart failure clinics to compare the prognostic value of 3 physical frailty scales in ambulatory patients with heart failure. Outcomes were all-cause death or hospitalization and health-related quality of life using the 36-Item Short Form survey questionnaire (SF-36) at 3 months. Multivariable regression was adjusted for age, sex, Meta-Analysis Global Group in Chronic Heart Failure score, and baseline SF-36 score. The cohort included 215 patients (mean age 77.6 years). All 3 frailty scales were independently associated with death or hospitalization at 3 months; the adjusted odds ratios standardized per 1 SD worsening of the Short Physical Performance Battery; Fried, and strength, assistance with walking, rising from a chair, climbing stairs, and falls scales were 1.67 (95% CI, 1.09-2.55), 1.60 (95% CI, 1.04-2.46), and 1.55 (95% CI, 1.03-2.35), respectively, with C statistics of 0.77 to 0.78. All 3 frailty scales were independently associated with worsening SF-36 scores, especially the Short Physical Performance Battery, for which 1 SD worsening of frailty translated to a decrement of -5.86 (-8.55 to -3.17) and -5.51 (-7.82 to -3.21) points in the Physical Component Score and Mental Component Score. Conclusions All 3 physical frailty scales were associated with death, hospitalization, and reduced health-related quality of life in ambulatory patients with heart failure. Questionnaire or performance-based physical frailty scales can be used to offer prognostic value and a therapeutic target in this vulnerable population. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03887351.
衰弱在心力衰竭的老年患者中很常见，与不良预后相关；然而，在临床实践中如何衡量衰弱仍然存在不确定性。
在 4 家心力衰竭诊所进行了一项多中心前瞻性队列研究，以比较 3 种身体衰弱量表在有症状的心力衰竭患者中的预后价值。主要结局为全因死亡或住院和健康相关生活质量，使用 36 项简明健康调查问卷（SF-36）在 3 个月时进行评估。多变量回归调整了年龄、性别、慢性心力衰竭的 Meta 分析全球群组评分以及基线 SF-36 评分。队列纳入了 215 例患者（平均年龄 77.6 岁）。所有 3 种衰弱量表均与 3 个月时的死亡或住院相关；按 1 SD 恶化的标准化调整后短躯体表现电池、Fried 以及力量、行走辅助、从椅子上起身、爬楼梯和跌倒量表的比值比分别为 1.67（95%可信区间，1.09-2.55）、1.60（95%可信区间，1.04-2.46）和 1.55（95%可信区间，1.03-2.35），C 统计值为 0.77 至 0.78。所有 3 种衰弱量表均与 SF-36 评分恶化独立相关，特别是短躯体表现电池，衰弱恶化 1 SD 相当于身体成分评分和精神成分评分分别下降 -5.86（-8.55 至-3.17）和-5.51（-7.82 至-3.21）。
所有 3 种身体衰弱量表均与有症状心力衰竭患者的死亡、住院和健康相关生活质量降低相关。问卷或基于表现的身体衰弱量表可用于提供这一脆弱人群的预后价值和治疗靶点。
