Okoye Chukwuma, Morelli Virginia, Franchi Riccardo, Mazzarone Tessa, Guarino Daniela, Maccioni Lorenzo, Cargiolli Cristina, Calsolaro Valeria, Niccolai Filippo, Virdis Agostino
School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, MI, Italy.
Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Eur Geriatr Med. 2024 Dec;15(6):1839-1847. doi: 10.1007/s41999-024-01054-2. Epub 2024 Sep 27.
Sarcopenia is a potentially reversible syndrome that increases the risk of cardiogenic cachexia and adverse outcomes in older patients with heart failure (HF). Despite its clinical significance, sarcopenia remains underdiagnosed due to the complexities of comprehensive assessment in patients with acute HF. This study aimed to evaluate whether the SARC-F questionnaire, its inviduals components, and the handgrip strength test (HGS) can predict short-term prognostic risk in very old patients recently discharged after acute HF.
We consecutively enrolled patients aged 75 years or older hospitalized with acute HF in the Geriatrics Unit of a tertiary care hospital. All patients underwent physical examination, complete blood tests, point-of-care ultrasound, and a comprehensive geriatric assessment, including physical performance through SARC-F and HGS. The thirty-day post-discharge mortality rate was assessed by phone interview.
Out of 184 patients hospitalized with acute HF who were enrolled in the study (mean [SD], 86.8 [5.9] years, 60.3% female), 47 died within 30 days after discharge. By multivariate logistic analysis, HGS (β = - 0.73 ± 0.03, p = 0.008) and SARC-F [adjusted OR = 1.18 (CI 95% 1.03-1.33), p = 0.003] resulted independently associated with mortality. Furthermore, two SARC-F sub-items, namely, limitation in rising from a chair and history of falls [aOR: 3.26 (CI95% 1.27-8.34), p = 0.008; aOR: 3.30 (CI 95% 1.28-8.49), p = 0.01; respectively] emerged as determinants of 30-days mortality.
SARC-F and HGS test independently predict 30-day post-discharge mortality in oldest-old patients hospitalized for acute HF.
肌肉减少症是一种潜在可逆的综合征，会增加老年心力衰竭（HF）患者发生心源性恶病质和不良结局的风险。尽管其具有临床意义，但由于急性HF患者综合评估的复杂性，肌肉减少症仍未得到充分诊断。本研究旨在评估SARC-F问卷、其各个组成部分以及握力测试（HGS）是否能够预测急性HF后近期出院的高龄患者的短期预后风险。
我们连续纳入了一家三级护理医院老年病科因急性HF住院的75岁及以上患者。所有患者均接受了体格检查、全血细胞计数、床旁超声检查以及全面的老年综合评估，包括通过SARC-F和HGS评估身体功能。出院后30天的死亡率通过电话访谈进行评估。
在纳入研究的184例因急性HF住院的患者中（平均[标准差]，86.8[5.9]岁，60.3%为女性），47例在出院后30天内死亡。通过多因素逻辑分析，HGS（β=-0.73±0.03，p=0.008）和SARC-F[调整后的比值比=1.18（95%置信区间1.03-1.33），p=0.003]与死亡率独立相关。此外，SARC-F的两个子项目，即从椅子上起身受限和跌倒史[调整后的比值比：3.26（95%置信区间1.27-8.34），p=0.008；调整后的比值比：3.30（95%置信区间1.28-8.49），p=0.01]分别成为30天死亡率的决定因素。
SARC-F和HGS测试可独立预测因急性HF住院的高龄患者出院后30天的死亡率。
