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衰弱对住院老年心力衰竭患者急性加重再入院及全因死亡的影响

Effect of frailty on acute exacerbation readmission and all-cause mortality of hospitalized elderly patients with heart failure

    摘要
  • 摘要:
    目的  了解老年心力衰竭（心衰）患者衰弱发生率及衰弱对其急性加重再入院和全因死亡的影响。
    方法  纳入2023年9月至2024年7月在中国科学技术大学附属第一医院因心衰住院的60～80岁患者，根据衰弱筛查量表（FRAIL）评估情况将患者分为非衰弱组与衰弱组，对出院后1年进行规范化随访，记录不良事件发生情况，统计复合终点事件（包括因心衰急性加重再入院和全因死亡）。
    结果  共纳入228例患者，平均年龄（71.1±5.7）岁，衰弱患者69例（30.3%）。衰弱组的纽约心脏协会心功能分级（NYHA分级）更高，服药种数及合并脑梗死更多，淋巴细胞百分比、血钠较低，而尿酸、血肌酐、N末端B型利钠肽原（NT-proBNP）升高。随访1年结果显示，复合终点事件89例（39.0%），全因死亡15例（6.6%），失访1例（0.4%），衰弱组复合终点事件发生率（65.2% vs. 27.7%，P ＜ 0.001）、心衰再入院率（50.7% vs. 24.5%，P ＜ 0.001）和全因死亡率（14.5% vs. 3.1%，P = 0.001）均高于非衰弱组。Kaplan-Meier生存曲线分析显示衰弱组累积事件率更高（P ＜ 0.001）。多因素Cox回归分析显示，衰弱是复合终点事件（HR = 4.867，95%CI 2.420～9.789，P ＜ 0.001）和心衰再入院（HR = 2.530，95%CI 1.348～4.747，P = 0.004）的独立危险因素。
    结论  衰弱在老年心衰住院患者中发生率较高，且为不良预后的独立预测因素，是临床医师在临床评估和制定治疗策略时需考虑的重要因素。

     

    Abstract:
    Objective To investigate the incidence of frailty in elderly patients with heart failure(HF) and the impact of frailty on their acute exacerbation readmission and all-cause mortality.
    Methods Elderly patients with HF, aged 60-80 years, who were hospitalized in the First Affiliated Hospital of the University of Science and Technology of China from September 2023 to July 2024 were retrospectively included. According to the frailty screening scale (FS) score, all patients were divided into the non-frailty and frailty groups. Standardized follow-up was conducted for 1 year after discharge. The occurrence of adverse events was recorded. Composite endpoint events included readmission for acute exacerbation of HF and all-cause mortality.
    Results A total of 228 patients were included, with an average age of (71.1±5.7) years. 69 (30.3%) patients were diagnosed with frailty. In the frailty group, NYHA grade was higher, the dose was higher and the incidence of cerebral infarction was higher, the lymphocyte percentage and blood sodium level were lower, while the levels of uric acid, serum creatinine, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were elevated. The results of 1-year follow-up showed that 89 cases (39.0%) had composite endpoint events, 15 cases (6.6%) of all-cause mortality, and 1 case (0.4%) lost to follow-up, and the incidence of composite endpoint events in the frailty group (65.2% vs. 27.7%, P ＜ 0.001), readmission rate due to HF (50.7% vs. 24.5%, P ＜ 0.001) and all-cause mortality (14.5% vs. 3.1%, P = 0.001) were higher than those in the non-frailty group. Kaplan-Meier survival curve analysis showed that the cumulative event rate was higher in the frailty group (P ＜ 0.0001). Multivariate Cox’s regression analysis confirmed that frailty was an independent risk factor for composite endpoint events (HR = 4.867, 95%CI 2.420-9.789, P ＜ 0.001) and readmission due to HF (HR = 2.530, 95%CI 1.348-4.747, P = 0.004).
    Conclusions The incidence of frailty is high in elderly patients with HF. Frailty is an independent predictor of poor prognosis, which is an important factor for clinicians to consider in clinical evaluation and treatment decision-making.

     

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