指南指导的药物治疗对营养不良的体弱老年射血分数降低的急性心力衰竭患者的有效性。
Effectiveness of Guideline-Directed Medical Therapy for Acute Heart Failure With Reduced Ejection Fraction in Frail Elderly Patients With Malnutrition.
作者信息
Takaoka Yoshimitsu, Rahman Mahbubur, Asano Taku, Kijima Yasufumi, Aoki Jiro
机构信息
Department of Cardiovascular Medicine, St. Luke's International Hospital Tokyo Japan.
Division of Epidemiology, Graduate School of Public Health, St. Luke's International University Tokyo Japan.
出版信息
Circ Rep. 2025 Feb 28;7(4):267-274. doi: 10.1253/circrep.CR-25-0003. eCollection 2025 Apr 10.
BACKGROUND
The appropriateness of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in malnourished elderly patients is unclear. This study aims to assess the effects of GDMT on acute heart failure (AHF) with reduced ejection fraction in this specific population using the Geriatric Nutritional Risk Index (GNRI).
METHODS AND RESULTS
We retrospectively collected data of patients aged >75 years who were admitted to St. Luke's International Hospital for AHF with reduced ejection fraction from 2011 to 2022. Malnutrition was defined as a GNRI score <92. GDMT was defined as the prescription of 3 or more of the medications for HFrEF at the time of discharge. Among 467 patients, 345 (73.9%) had malnutrition. In the low GNRI group, GDMT was associated with a lower all-cause mortality at 1 year (HR 0.46; 95% CI 0.24-0.89; P=0.021), but not in heart failure (HF) readmission (HR 0.83; 95% CI 0.55-1.25; P=0.364) at 1 year after discharge. In the high GNRI group, GDMT was not significantly associated with these outcomes (all-cause mortality: HR 0.59; 95% CI 0.12-3.06; P=0.534; HF readmission: HR 0.55; 95% CI 0.29-1.05; P=0.069).
CONCLUSIONS
Implementation of GDMT in AHF with reduced ejection fraction may enhance prognosis, even among elderly patients with malnutrition.
背景
对于营养不良的老年射血分数降低的心力衰竭（HFrEF）患者，指南指导的药物治疗（GDMT）是否合适尚不清楚。本研究旨在使用老年营养风险指数（GNRI）评估GDMT对这一特定人群中射血分数降低的急性心力衰竭（AHF）的影响。
方法与结果
我们回顾性收集了2011年至2022年因射血分数降低的AHF入住圣卢克国际医院的75岁以上患者的数据。营养不良定义为GNRI评分<92。GDMT定义为出院时开具3种或更多治疗HFrEF的药物处方。在467例患者中，345例（73.9%）存在营养不良。在低GNRI组中，GDMT与1年时较低的心衰全因死亡率相关（HR 0.46；95%CI 0.24-0.89；P=0.021），但与出院后1年的心衰（HF）再入院率无关（HR 0.83；95%CI 0.55-1.25；P=0.364）。在高GNRI组中，GDMT与这些结局无显著相关性（全因死亡率：HR 0.59；95%CI 0.12-3.06；P=0.534；HF再入院率：HR 0.55；95%CI 0.29-1.05；P=0.069）。
结论
在射血分数降低的AHF中实施GDMT可能改善预后，即使在营养不良的老年患者中也是如此。
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