Yang Mei, Zhang Xiuting, Fang Wenjie, Zhang Yilin, Fan Xiuzhen
School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China.
J Clin Nurs. 2025 Oct;34(10):4259-4272. doi: 10.1111/jocn.17647. Epub 2025 Jan 14.
This study aimed to identify the heterogeneous trajectories of frailty and determine the predictors of distinct trajectories in patients with heart failure.
A longitudinal study.
A total of 253 patients with heart failure were recruited at the cardiology department of a tertiary hospital between February and December 2023. Frailty was assessed at baseline, 1 and 4 months after discharge. Patients' sociodemographic characteristics, physical symptoms, nutritional status, psychological distress, illness perception and social networks were obtained at baseline using a structured questionnaire. Group-based trajectory modelling was performed to identify the heterogeneity of the trajectories of frailty. Multiple logistic regression and decision tree models were used to explore the predictors of heterogeneous trajectories of frailty.
Three distinct trajectories of frailty were identified in patients with heart failure: low frailty with high-degree improvement group (46.2%), moderate frailty with high-degree improvement group (41.1%) and high frailty with low-degree improvement group (12.6%). Multiple logistic regression analysis showed that physical symptoms, nutritional status, illness perception and employment status were entered as independent predictors of heterogeneous trajectories of frailty. The decision tree model demonstrated that physical symptoms were the primary predictors, followed by nutritional status, illness perception and psychological distress.
Three distinct categories of frailty trajectories were identified in patients with heart failure. Physical symptoms, nutritional status, psychological distress, illness perception and employment status were independent predictors of heterogeneous trajectories of frailty, with physical symptoms being the most important predictor.
Dynamic frailty assessment is recommended. Interventions aimed at alleviating physical symptoms, psychological distress and negative illness perception, and improving nutritional status may be conducive to delaying or reversing frailty in patients with heart failure, particularly in unemployed individuals.
The reporting followed the STROBE guideline.
No patient or public contribution.
本研究旨在确定心力衰竭患者衰弱的异质性轨迹，并确定不同轨迹的预测因素。
一项纵向研究。
2023年2月至12月期间，在一家三级医院的心脏病科招募了总共253例心力衰竭患者。在基线、出院后1个月和4个月时评估衰弱情况。使用结构化问卷在基线时获取患者的社会人口学特征、身体症状、营养状况、心理困扰、疾病认知和社交网络信息。采用基于群体的轨迹模型来识别衰弱轨迹的异质性。使用多因素逻辑回归和决策树模型来探索衰弱异质性轨迹的预测因素。
在心力衰竭患者中确定了三种不同的衰弱轨迹：低度衰弱且改善程度高的组（46.2%）、中度衰弱且改善程度高的组（41.1%）和高度衰弱且改善程度低的组（12.6%）。多因素逻辑回归分析表明，身体症状、营养状况、疾病认知和就业状况被纳入作为衰弱异质性轨迹的独立预测因素。决策树模型显示，身体症状是主要预测因素，其次是营养状况、疾病认知和心理困扰。
在心力衰竭患者中确定了三类不同的衰弱轨迹。身体症状、营养状况、心理困扰、疾病认知和就业状况是衰弱异质性轨迹的独立预测因素，其中身体症状是最重要的预测因素。
建议进行动态衰弱评估。旨在减轻身体症状、心理困扰和消极疾病认知以及改善营养状况的干预措施可能有助于延缓或逆转心力衰竭患者的衰弱，尤其是失业个体。
报告遵循STROBE指南。
无患者或公众贡献。
