Abe Takuro, Jujo Kentaro, Fujimoto Yudai, Maeda Daichi, Ogasahara Yuki, Saito Kazuya, Saito Hiroshi, Iwata Kentaro, Konishi Masaaki, Kitai Takeshi, Kasai Takatoshi, Wada Hiroshi, Momomura Shin-Ichi, Kagiyama Nobuyuki, Kamiya Kentaro, Maekawa Emi, Matsue Yuya
Department of Cardiology, Nishiarai Heart Center Hospital, Japan.
Department of Cardiology, Saitama Medical Center, Japan.
Am Heart J Plus. 2024 Sep 27;46:100467. doi: 10.1016/j.ahjo.2024.100467. eCollection 2024 Oct.
Physical frailty and malnutrition coexist in older patients with heart failure (HF) and form a vicious cycle exacerbating each other and can cause poor clinical outcomes. We aimed to clarify the association of prevalence of physical frailty and malnutrition and clinical outcomes in hospitalized patients with HF.
A total of 862 hospitalized patients aged ≥65 years with HF decompensation were included in this FRAGILE-HF post-hoc sub-analysis. Patients were categorized into Neither, Either, or Both groups based on the prevalence of physical frailty and malnutrition. The primary outcome was all-cause mortality within 1 year after discharge. Prognoses among the groups were compared in the entire cohort and in subgroups with preserved ejection fraction (pEF) and reduced/mildly reduced left ventricular ejection fractions (rEF/mrEF).
The Neither, Either, and Both groups comprised 32 %, 40 %, and 28 % respectively. During a 1-year follow-up period, 101 (12 %) patients died. Kaplan-Meier analysis showed significant differences in the primary outcomes among the groups ( < 0.001). The Both group had a higher risk of mortality (HR: 2.47, 95 % CI: 1.38-4.42) than the Neither group, while the Either group showed insignificant risk increase (HR: 1.58, 95 % CI: 0.86-2.90). Similar trends were observed in the pEF and rEF/mrEF subgroups ( = 0.60).
Physical frailty and malnutrition coexist in approximately one-quarter of hospitalized older patients with HF and are associated with an increased risk of mortality. Assessing both conditions is crucial for risk stratification and interventions to mitigate their interplay.
身体虚弱和营养不良在老年心力衰竭（HF）患者中并存，形成恶性循环，相互加剧，可导致不良临床结局。我们旨在阐明住院HF患者身体虚弱和营养不良的患病率与临床结局之间的关联。
本FRAGILE-HF事后亚分析纳入了862例年龄≥65岁的HF失代偿住院患者。根据身体虚弱和营养不良的患病率，将患者分为无、单一或两者皆有组。主要结局是出院后1年内的全因死亡率。在整个队列以及射血分数保留（pEF）和左心室射血分数降低/轻度降低（rEF/mrEF）的亚组中比较各组的预后。
无、单一和两者皆有组分别占32%、40%和28%。在1年的随访期内，101例（12%）患者死亡。Kaplan-Meier分析显示各组间主要结局存在显著差异（<0.001）。两者皆有组的死亡风险高于无组（HR：2.47，95%CI：1.38-4.42），而单一组的风险增加不显著（HR：1.58，95%CI：0.86-2.90）。在pEF和rEF/mrEF亚组中观察到类似趋势（=0.60）。
约四分之一的老年HF住院患者同时存在身体虚弱和营养不良，且与死亡风险增加相关。评估这两种情况对于风险分层和减轻它们之间相互作用的干预措施至关重要。
