根据心力衰竭患者的虚弱程度使用医学治疗与临床事件风险的关系：一项真实队列研究。

Use of medical therapy and risk of clinical events according to frailty in heart failure patients - A real-life cohort study.

机构信息

Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark.

Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

出版信息

Eur J Heart Fail. 2024 Aug;26(8):1717-1726. doi: 10.1002/ejhf.3249. Epub 2024 May 3.

DOI:10.1002/ejhf.3249

PMID:38700461

Abstract

AIMS

Although recent randomized clinical trials have demonstrated the advantages of heart failure (HF) therapy in both frail and not frail patients, there is insufficient information on the use of HF therapy based on frailty status in a real-world setting. The aim was to examine how frailty status in HF patients associates with use of HF therapy and with clinical outcomes.

METHODS AND RESULTS

Patients with new-onset HF between 2014 and 2021 were identified using the nationwide Danish registers. Patients across the entire range of ejection fraction were included. The associations between frailty status (using the Hospital Frailty Risk Score) and use of HF therapy and clinical outcomes (all-cause mortality, HF hospitalization, and non-HF hospitalization) were evaluated using multivariable-adjusted Cox models adjusting for age, sex, diagnostic setting, calendar year, comorbidities, pharmacotherapy, and socioeconomic status. Of 35 999 participants (mean age 69.1 years), 68% were not frail, 26% were moderately frail, and 6% were severely frail. The use of HF therapy was significantly lower in frailer patients. The hazard ratio (HR) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker initiation was 0.74 (95% confidence interval 0.70-0.77) and 0.48 (0.43-0.53) for moderate frailty and severe frailty, respectively. For beta-blockers, the corresponding HRs were 0.74 (0.71-0.78) and 0.51 (0.46-0.56), respectively, and for mineralocorticoid receptor antagonists, 0.83 (0.80-0.87) and 0.58 (0.53-0.64), respectively. The prevalence of death and non-HF hospitalization increased with frailty status. The HR for death was 1.55 (1.47-1.63) and 2.32 (2.16-2.49) for moderate and severe frailty, respectively, and the HR for non-HF hospitalization was 1.37 (1.32-1.41) and 1.82 (1.72-1.92), respectively. The association between frailty status and HF hospitalization was not significant (HR 1.08 [1.02-1.14] and 1.08 [0.97-1.20], respectively).

CONCLUSION

In real-world HF patients, frailty was associated with lower HF therapy use and with a higher incidence of clinical outcomes including mortality and non-HF hospitalization.

摘要

目的

尽管最近的随机临床试验已经证明了心力衰竭（HF）治疗在虚弱和非虚弱患者中的优势，但在真实世界环境中，基于虚弱状态使用 HF 治疗的信息还不够充分。本研究旨在探讨 HF 患者的虚弱状态与 HF 治疗的使用以及临床结局之间的关系。

方法和结果

使用全国丹麦登记册确定了 2014 年至 2021 年间新发 HF 的患者。纳入了射血分数（EF）整个范围内的患者。使用医院衰弱风险评分（Hospital Frailty Risk Score）评估衰弱状态与 HF 治疗和临床结局（全因死亡率、HF 住院和非 HF 住院）之间的关系，使用多变量调整的 Cox 模型进行调整，包括年龄、性别、诊断环境、日历年度、合并症、药物治疗和社会经济状况。在 35999 名参与者中（平均年龄 69.1 岁），68%的患者无虚弱，26%的患者中度虚弱，6%的患者严重虚弱。虚弱患者 HF 治疗的使用率明显较低。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂起始的危险比（HR）分别为 0.74（95%置信区间 0.70-0.77）和 0.48（0.43-0.53），用于中度和严重衰弱。β受体阻滞剂的相应 HR 分别为 0.74（0.71-0.78）和 0.51（0.46-0.56），而对于盐皮质激素受体拮抗剂，相应 HR 分别为 0.83（0.80-0.87）和 0.58（0.53-0.64）。死亡率和非 HF 住院的发生率随虚弱程度的增加而增加。死亡的 HR 分别为中度和严重衰弱的 1.55（1.47-1.63）和 2.32（2.16-2.49），而非 HF 住院的 HR 分别为 1.37（1.32-1.41）和 1.82（1.72-1.92）。衰弱状态与 HF 住院之间的关联不显著（HR 分别为 1.08 [1.02-1.14]和 1.08 [0.97-1.20]）。