Esposito Augusto, Foffa Ilenia, Vecoli Cecilia, Bastiani Luca, Berti Sergio, Mazzone Annamaria
Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy.
CNR Institute of Clinical Physiology, 54100 Massa, Italy.
J Cardiovasc Dev Dis. 2024 May 14;11(5):150. doi: 10.3390/jcdd11050150.
Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for "frailty-based management" of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8; = 0.007), and death (41.9% vs. 12.8%; < 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3-10.7; = 0.01) and hospital readmission (OR: 3.6 CI 1.1-11.6; = 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04-6.74; -value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.
衰弱程度在老年重度主动脉瓣狭窄（AS）患者的决策制定和治疗结果中起着关键作用。急性心力衰竭（AHF）会导致该人群的临床血流动力学状况严重恶化。本研究旨在评估AHF对因AS而接受定制介入治疗的老年患者衰弱程度和治疗结果的影响。共有109例患者（68%为女性；平均年龄83.3±5.4岁），通过多学科路径对瓣膜疾病进行“基于衰弱的管理”评估，分为两组，一组有AHF（AHF+），另一组无AHF（AHF-）且射血分数保留（平均值EF：57.4±8.6）。AHF发生在老年、临床和手术评估前平均55天。对全因死亡率和再入院情况进行了20个月的随访。AHF+患者出现高级衰弱的频率更高（分别为53.3%和46.7%）、再住院率更高（35.5%对12.8%；P = 0.007）以及死亡率更高（41.9%对12.8%；P < 0.001）。在逐步逻辑回归分析中，AHF成为高级衰弱（OR：3.8，CI 1.3 - 10.7；P = 0.01）和医院再入院（OR：3.6，CI 1.1 - 11.6；P = 0.03）的独立危险因素。此外，先前的AHF是与较高死亡风险相关的独立决定因素（HR 2.65；CI 95% 1.04 - 6.74；P值0.04）。AHF与老年重度AS患者的高级衰弱和不良结局独立相关。因此，该人群需要仔细的临床和老年医学监测，并在衰弱早期实施AS介入治疗，以避免AHF的发生和不良结局。
