Żółkowska Bernadetta, Lee Christopher S, Denfeld Quin E, Jędrzejczyk Maria, Diakowska Dorota, Lisiak Magdalena, Wleklik Marta, Czapla Michał, Uchmanowicz Izabella
Student Research Club of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, 51-618 Wroclaw, Poland.
Boston College William F. Connell School of Nursing, Chestnut Hill, MA 02467, USA.
J Clin Med. 2024 Dec 2;13(23):7345. doi: 10.3390/jcm13237345.
: Heart failure (HF) is a significant public health issue with high morbidity and mortality rates. This study aims to investigate the interrelationships between frailty, cognitive impairment, and depression in older adults with HF, specifically focusing on how the physical and neuropsychiatric dimensions of frailty contribute to cognitive decline. : This study included 250 patients aged 60 years or older, diagnosed with HF and hospitalized for acute decompensated HF. The patients were assessed using standardized protocols for frailty, cognitive function, and depression. The frailty was evaluated using Fried's phenotype criteria, cognitive function with MMSE and MoCA, and depression and anxiety with HADS and PHQ-9. Statistical analyses included univariable and multivariable linear regression to identify the predictors of frailty. : Of the 250 patients, 151 (60.4%) were identified as frail. The frail patients were older (mean age 73.58 ± 6.80 years) compared to the non-frail patients (mean age 70.39 ± 6.16 years, = 0.0002). Significant differences were observed in the NYHA class, length of the hospital stay, and prevalence of diabetes mellitus. The frail patients had worse cognitive (MMSE: 27.39 ± 2.12 vs. 28.13 ± 1.72, = 0.004; MoCA: 24.68 ± 3.65 vs. 25.64 ± 3.98, = 0.050) and psychological outcomes (higher prevalence of marked depression based on HADS categories: 8.61% vs. 1.01%, = 0.021; and PHQ-9 categories: severe depression: 2.65% vs. 1.01%, < 0.001). : Age, C-reactive protein (CRP) levels, and anxiety were identified as independent predictors of frailty in the patients with heart failure. Depression, cognitive dysfunction, and the length of the hospital stay showed significant differences between the frail and non-frail patients in the group comparisons but were not independent predictors.
心力衰竭（HF）是一个重要的公共卫生问题，发病率和死亡率都很高。本研究旨在调查老年心力衰竭患者虚弱、认知障碍和抑郁之间的相互关系，特别关注虚弱的身体和神经精神维度如何导致认知衰退。
本研究纳入了250名60岁及以上、被诊断为心力衰竭并因急性失代偿性心力衰竭住院的患者。使用标准化方案对患者进行虚弱、认知功能和抑郁评估。采用Fried表型标准评估虚弱，用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能，用医院焦虑抑郁量表（HADS）和患者健康问卷-9（PHQ-9）评估抑郁和焦虑。统计分析包括单变量和多变量线性回归，以确定虚弱的预测因素。
在这250名患者中，151名（60.4%）被确定为虚弱。与非虚弱患者（平均年龄70.39±6.16岁，P = 0.0002）相比，虚弱患者年龄更大（平均年龄73.58±6.80岁）。在纽约心脏协会（NYHA）分级、住院时间和糖尿病患病率方面观察到显著差异。虚弱患者的认知功能更差（MMSE：27.39±2.12 vs. 28.13±1.72，P = 0.004；MoCA：24.68±3.65 vs. 25.64±3.98，P = 0.050），心理结果也更差（根据HADS分类，明显抑郁的患病率更高：8.61% vs. 1.01%，P = 0.021；根据PHQ-9分类，重度抑郁：2.65% vs. 1.01%，P < 0.001）。
年龄、C反应蛋白（CRP）水平和焦虑被确定为心力衰竭患者虚弱的独立预测因素。在组间比较中，抑郁、认知功能障碍和住院时间在虚弱和非虚弱患者之间存在显著差异，但不是独立预测因素。
