Duong Mai H, Gnjidic Danijela, McLachlan Andrew J, Winardi Kevin, Bennett Alexandra A, Blyth Fiona, Le Couteur David, Hilmer Sarah N
Laboratory of Ageing and Pharmacology, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2025 Feb;55(2):249-259. doi: 10.1111/imj.16612. Epub 2024 Dec 19.
Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence.
To evaluate utilisation of HF pharmacotherapy and prevalence of polypharmacy, adverse drug events (ADEs), falls, delirium, renal impairment and duration of hospitalisation in older inpatients, according to frailty.
A retrospective cross-sectional study of the TO HOME cohort of 2000 inpatients ≥75 years admitted for ≥48 h to rehabilitation, geriatric or general medicine from 1 July 2016 to 30 June 2017 across six hospitals in Sydney, Australia. Data were collected from electronic medical records. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification identified HF diagnosis, ADEs and frailty using hospital frailty risk score. Outcomes included utilisation of HF pharmacotherapy; polypharmacy; ADEs, falls, delirium, renal and impairment; and duration of hospitalisation.
Among 439 (22.0% of TO HOME cohort) patients with undifferentiated HF, 284 (69.5%) had intermediate or high risk of frailty, and 412 (94%) took ≥1 HF pharmacotherapy, with 357 (81.3%) patients on loop diuretics. Patients with high frailty risk frequently continued beta-blockers (70%) and discontinued renin-angiotensin system inhibitors (57%). Most patients experienced polypharmacy (n = 426, 97.0%). Renal impairment prevalence was 67%-76% across frailty groups. Increasing frailty risk (low, intermediate and high) was associated with increasing prevalence of ADEs (31%, 56% and 84%), falls (12%, 25% and 46%) and delirium (8%, 27% and 49%) and longer hospitalisation.
Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.
由于证据有限，体弱老年人的最佳心力衰竭（HF）药物治疗（指南指导的药物治疗和利尿剂）尚不确定。
根据体弱程度评估老年住院患者HF药物治疗的使用情况、多重用药的患病率、不良药物事件（ADEs）、跌倒、谵妄、肾功能损害及住院时间。
对2016年7月1日至2017年6月30日期间在澳大利亚悉尼六家医院接受康复、老年病或普通内科治疗≥48小时的2000名≥75岁住院患者的TO HOME队列进行回顾性横断面研究。数据从电子病历中收集。使用医院体弱风险评分，根据《国际疾病和相关健康问题统计分类，第十次修订版，澳大利亚修订本》确定HF诊断、ADEs和体弱情况。结果包括HF药物治疗的使用情况；多重用药；ADEs、跌倒、谵妄、肾功能损害；以及住院时间。
在439名（占TO HOME队列的22.0%）未分化HF患者中，284名（69.5%）有中度或高度体弱风险，412名（94%）接受了≥1种HF药物治疗，其中357名（81.3%）患者使用袢利尿剂。体弱风险高的患者经常继续使用β受体阻滞剂（70%），并停用肾素-血管紧张素系统抑制剂（57%）。大多数患者存在多重用药情况（n = 426, 97.0%）。各体弱组的肾功能损害患病率为67%-76%。体弱风险增加（低、中、高）与ADEs患病率增加（31%、56%和84%）、跌倒患病率增加（12%、25%和46%）、谵妄患病率增加（8%、27%和49%）以及住院时间延长相关。
体弱、住院期间HF药物治疗的变化以及ADEs在老年HF住院患者中很常见。根据体弱程度与不良结局之间的关联需要进一步研究。HF表型记录不佳可能是老年住院患者药物优化的障碍。
