Granata Nicolò, Vigorè Martina, Vaninetti Raffaella, Maestri Roberto, Borri Roberta, Caporotondi Angelo, Piaggi Giancarlo, Cremonese Gioele, Pierobon Antonia
Department of Cardiac Respiratory Rehabilitation, Istituto Maugeri IRCCS Tradate, Varese, Italy.
Unit of Psychology, Istituto Maugeri IRCCS Montescano, Pavia, Italy -
Minerva Cardiol Angiol. 2025 Feb;73(1):120-128. doi: 10.23736/S2724-5683.24.06555-4. Epub 2024 Oct 8.
Chronic heart failure (CHF) is often associated with cognitive, psychological, and functional disorders. In addition, since patients suffering from this condition are often older adults, the presence of frailty could worsen the clinical situation.
The present multicentric observational study aimed to investigate, through a multidimensional evaluation, the associations between clinical, functional, cognitive, psychological, and frailty variables of older (age ≥65) CHF inpatients undergoing cardiac rehabilitation and to identify the eventual independent predictors of the frailty status.
The study included 85 patients (mean age 73.88±5.84). The disease severity of the sample was moderate (left ventricular ejection fraction = 41.79±15.40). Among the patients, 32.94% had cognitive impairment, 12.94% and 14.11% reported moderate to severe anxious or depressive symptoms, respectively, and 34.12% were classified as frail (Clinical Frailty Scale [CFS] score ≥5). The CFS score showed a negative correlation with cognitive status (Addenbrooke's Cognitive Examination III [ACE III] [r=-0.48, P≤0.0001] and Frontal Assessment Battery [FAB] [r=-0.33, P=0.0001]) and functional status (Short Physical Performance Battery [SPPB] [r=-0.55, P≤0.0001] and Barthel Index [r=-0.52, P≤0.0001]), while showing a positive correlation with comorbidities (Cumulative Illness Rating Scale [CIRS] [r=0.40, P≤0.0001]). The stepwise regression analysis revealed that ACE III, SPPB, and CIRS were independent predictors of frailty status (CFS).
Frailty is an important variable that should be considered since it is linked with most of the variables that play a role in the management and outcomes of older CHF patients and, thus, its evaluation should be integrated into the usual assessment in cardiac rehabilitation.
慢性心力衰竭（CHF）常与认知、心理和功能障碍相关。此外，由于患有这种疾病的患者通常是老年人，虚弱的存在可能会使临床情况恶化。
本多中心观察性研究旨在通过多维评估，调查接受心脏康复的老年（年龄≥65岁）CHF住院患者的临床、功能、认知、心理和虚弱变量之间的关联，并确定虚弱状态的最终独立预测因素。
该研究纳入了85名患者（平均年龄73.88±5.84岁）。样本的疾病严重程度为中度（左心室射血分数 = 41.79±15.40）。在患者中，32.94%有认知障碍，12.94%和14.11%分别报告有中度至重度焦虑或抑郁症状，34.12%被归类为虚弱（临床虚弱量表[CFS]评分≥5）。CFS评分与认知状态（Addenbrooke认知检查III[ACE III][r = -0.48，P≤0.0001]和额叶评估量表[FAB][r = -0.33，P = 0.0001]）以及功能状态（简短体能表现量表[SPPB][r = -0.55，P≤0.0001]和Barthel指数[r = -0.52，P≤0.0001]）呈负相关，而与合并症（累积疾病评定量表[CIRS][r = 0.40，P≤0.0001]）呈正相关。逐步回归分析显示，ACE III、SPPB和CIRS是虚弱状态（CFS）的独立预测因素。
虚弱是一个重要变量，应予以考虑，因为它与在老年CHF患者的管理和预后中起作用的大多数变量相关，因此，其评估应纳入心脏康复的常规评估中。
