多领域衰弱对老年心力衰竭患者死亡模式的影响：一项队列研究。

Impact of Multidomain Frailty on the Mode of Death in Older Patients With Heart Failure: A Cohort Study.

机构信息

Department of Cardiovascular Biology and Medicine (K.O., Y.M., D.M., Y.F., N.K., T.S., T.D., M.H., T.K., T.M.), Juntendo University Graduate School of Medicine, Tokyo, Japan.

Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan (K.O.).

出版信息

Circ Cardiovasc Qual Outcomes. 2024 May;17(5):e010416. doi: 10.1161/CIRCOUTCOMES.123.010416. Epub 2024 Mar 26.

DOI:10.1161/CIRCOUTCOMES.123.010416

PMID:38529634

Abstract

BACKGROUND

Although frailty is strongly associated with mortality in patients with heart failure (HF), the risk of which specific cause of death is associated with being complicated with frailty is unclear. We aimed to clarify the association between multidomain frailty and the causes of death in elderly patients hospitalized with HF.

METHODS

We analyzed data from the FRAGILE-HF cohort, where patients aged 65 years and older, hospitalized with HF, were prospectively registered between 2016 and 2018 in 15 Japanese hospitals before discharge and followed up for 2 years. All patients were assessed for physical, social, and cognitive dysfunction, and categorized into 3 groups based on their number of frailty domains (FDs, 0-1, 2, and 3). Kaplan-Meier survival analysis was used to evaluate the association between the number of FDs and all-cause mortality, whereas Fine-Gray competing risk regression analysis was used for assessing the impact on cause-specific mortality.

RESULTS

We analyzed 1181 patients with HF (81 years old in median, 57.4% were male), 530 (44.9%), 437 (37.0%), and 214 (18.1%) of whom were categorized into the FD 0 to 1, FD 2, and FD 3 groups, respectively. During the 2-year follow-up, 240 deaths were observed (99 HF deaths, 34 cardiovascular deaths, and 107 noncardiovascular deaths), and an increase in the number of FD was significantly associated with mortality (Log-rank: <0.001). The Fine-Gray competing risk analysis adjusted for age and sex showed that FDs 2 (subdistribution hazard ratio, 1.77 [95% CI, 1.11-2.81]) and 3 (2.78, [95% CI, 1.69-4.59]) groups were associated with higher incidence of noncardiovascular death but not with HF and other cardiovascular deaths.

CONCLUSIONS

Although multidomain frailty is strongly associated with mortality in older patients with HF, it is mostly attributable to noncardiovascular death and not cardiovascular death, including HF death.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023929.

摘要

背景

衰弱与心力衰竭（HF）患者的死亡率密切相关，但哪种特定的死亡原因与衰弱有关尚不清楚。我们旨在阐明老年 HF 住院患者多领域衰弱与死亡原因之间的关系。

方法

我们分析了 FRAGILE-HF 队列的数据，该队列于 2016 年至 2018 年期间在 15 家日本医院前瞻性登记了年龄在 65 岁及以上、因 HF 住院的患者，在出院前进行了评估，并随访了 2 年。所有患者均进行了身体、社会和认知功能障碍评估，并根据衰弱域（FD）数量（0-1、2 和 3）分为 3 组。使用 Kaplan-Meier 生存分析评估 FD 数量与全因死亡率之间的关系，而 Fine-Gray 竞争风险回归分析用于评估对特定原因死亡率的影响。

结果

我们分析了 1181 例 HF 患者（中位年龄 81 岁，57.4%为男性），其中 530 例（44.9%）、437 例（37.0%）和 214 例（18.1%）分别归入 FD 0-1、FD 2 和 FD 3 组。在 2 年的随访期间，观察到 240 例死亡（99 例 HF 死亡、34 例心血管死亡和 107 例非心血管死亡），FD 数量的增加与死亡率显著相关（对数秩检验：<0.001）。经年龄和性别调整的 Fine-Gray 竞争风险分析显示，FD 2（亚分布危险比，1.77[95%CI，1.11-2.81]）和 FD 3（2.78[95%CI，1.69-4.59]）组与非心血管死亡发生率较高相关，但与 HF 和其他心血管死亡无关。