系统老年评估对急性心力衰竭患者的预后影响。
Prognostic effect of systematic geriatric assessment on patients with acute heart failure.
机构信息
Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain.
Department Clinical Analysis, University Hospital of Burgos, Burgos, Spain.
出版信息
ESC Heart Fail. 2024 Apr;11(2):1194-1204. doi: 10.1002/ehf2.14692. Epub 2024 Jan 29.
AIMS
Frailty and dependence are frequent in patients admitted for acute heart failure (AHF), but their prognostic significance is unknown, especially in young adults. We aimed to study in adults admitted for AHF, regardless of age, the effect of frailty and dependence on the incidence of mortality and a combined event of mortality, readmissions for AHF, and visits to the emergency room (ER) for AHF at 1 and 6 months.
METHODS AND RESULTS
We designed a prospective cohort study by including all the patients with AHF admitted in our Cardiology Department from July 2020 through May 2021. A multidimensional geriatric assessment was performed during the admission. We clinically followed up the patients 6 months after discharge. We enrolled 202 patients. The mean age was 73 ± 12.32 years, and 100 (49.5%) of the patients were elderly (>75 years). Just 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty (FRAIL ≥ 3) was observed in 68 (33.7%) patients (mean FRAIL score: 1.88 ± 1.48). Dependence (Barthel < 100) was observed in 65 (32.2%) patients (mean Barthel index: 94.38 ± 11.21). Frailty and dependence showed a significant association with both prognostic events at 1 and 6 months. In the multivariable analysis, frailty was associated with higher mortality at 1 month [hazard ratio (HR) 12.61, 95% confidence interval (CI) 1.57-101.47, P = 0.017] but not at 6 months (HR 2.25, 95% CI 0.61-8.26, P = 0.224) or with the combined endpoint at neither 1 month (HR 1.64, 95% CI 0.54-5.03, P = 0.384) nor 6 months (HR 1.35, 95% CI 0.75-2.46, P = 0.320). Dependence was related to higher mortality at 1 month (HR 13.04, 95% CI 1.62-104.75, P = 0.016) and 6 months (HR 7.18, 95% CI 1.99-25.86, P = 0.003) and to higher incidence of the combined event at 1 month (HR 5.93, 95% CI 1.63-21.50, P = 0.007) and 6 months (HR 2.62, 95% CI 1.49-4.61, P = 0.001).
CONCLUSIONS
In AHF patients, frailty and dependence implied a worse prognosis, rising mortality, readmissions, and ER visits for AHF.
目的
衰弱和依赖在因急性心力衰竭（AHF）住院的患者中很常见，但它们的预后意义尚不清楚，尤其是在年轻成年人中。我们旨在研究无论年龄大小，因 AHF 住院的成年人中，衰弱和依赖对 1 个月和 6 个月时死亡率和死亡率、AHF 再入院以及因 AHF 到急诊室（ER）就诊的复合事件发生率的影响。
方法和结果
我们设计了一项前瞻性队列研究，纳入了 2020 年 7 月至 2021 年 5 月期间在我们心内科因 AHF 住院的所有患者。在入院期间进行了多维老年评估。我们在出院后 6 个月对患者进行临床随访。患者的平均年龄为 73±12.32 岁，100 名（49.5%）患者年龄较大（>75 岁）。只有 78 名患者（38.6%）为女性，100 名（49.5%）有既往 HF。68 名患者（33.7%）存在衰弱（FRAIL≥3）（平均 FRAIL 评分为 1.88±1.48）。65 名患者（32.2%）存在依赖（Barthel<100）（平均 Barthel 指数为 94.38±11.21）。衰弱和依赖与 1 个月和 6 个月时的两个预后事件均显著相关。在多变量分析中，衰弱与 1 个月时的死亡率较高相关（HR 12.61，95%CI 1.57-101.47，P=0.017），但与 6 个月时的死亡率无关（HR 2.25，95%CI 0.61-8.26，P=0.224）或与 1 个月和 6 个月时的复合终点无关（HR 1.64，95%CI 0.54-5.03，P=0.384）或 6 个月（HR 1.35，95%CI 0.75-2.46，P=0.320）。依赖与 1 个月时的死亡率较高相关（HR 13.04，95%CI 1.62-104.75，P=0.016）和 6 个月时的死亡率较高相关（HR 7.18，95%CI 1.99-25.86，P=0.003），并且与 1 个月时的复合事件发生率较高相关（HR 5.93，95%CI 1.63-21.50，P=0.007）和 6 个月时的复合事件发生率较高相关（HR 2.62，95%CI 1.49-4.61，P=0.001）。
结论
在 AHF 患者中，衰弱和依赖预示着预后较差，死亡率、再入院率和因 AHF 到急诊室就诊的风险增加。
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