摘要
目的探讨衰弱对老年射血分数减低的心力衰竭(HFrEF)患者的长期影响。方法回顾性分析2017年10月至2020年10月因慢性心力衰竭急性加重于首都医科大学附属北京朝阳医院心内科住院治疗的年龄≥75岁的HFrEF患者245例,根据临床衰弱量表(CFS)评分分为衰弱组(CFS 1~4分)135例和非衰弱组(CFS 5~9分)110例,比较2组的一般临床资料、临床用药以及预后,并且分析衰弱与死亡的相关影响因素。结果衰弱组心率、N末端B型钠尿肽前体、男性、糖尿病、冠心病、≥5种慢性病、左心室射血分数(LVEF)≤35%、贫血、肌钙蛋白I升高比例高于非衰弱组(P<0.05,P<0.01),体质量指数(BMI)、估算肾小球滤过率(eGFR)、日常生活活动能力量表评分低于非衰弱组(P<0.05,P<0.01)。衰弱组应用血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、血管紧张素受体脑啡肽酶抑制剂、β受体阻滞剂、钠-葡萄糖协同转运蛋白2抑制剂比例低于非衰弱组(P<0.01),衰弱组3个月内急诊/再住院、2年内死亡比例高于非衰弱组(P<0.05,P<0.01)。二元logistic回归分析显示,≥5种慢性病、LVEF≤35%、BMI、GFR为影响衰弱的独立危险因素(OR=0.167,95%CI:0.064~0.453,P=0.000;OR=0.306,95%CI:0.160~0.586,P=0.000;OR=0.868,95%CI:0.786~0.958,P=0.005;OR=0.966,95%CI:0.943~0.991,P=0.007),而≥5种慢性病、衰弱为影响心力衰竭患者死亡的独立危险因素(P<0.05)。结论衰弱在老年HFrEF患者中发病率高,衰弱患者不易接受指南引导药物治疗,是老年HFrEF心力衰竭患者远期病死率的独立危险因素。
Objective To investigate the long-term effect of frailty on heart failure with reduced ejection fraction(HFrEF)in elderly patients.Methods A retrospective analysis was conducted on 245HFrEF patients aged≥75years admitted to our hospital from October 2017to October 2020 due to acute exacerbation of chronic heart failure(HF).Based on their clinical frailty scale(CFS)score,they were divided into frailty group(1-4,135cases)and non-frailty group(5-9,110 cases).Their general clinical data,clinical medication,and prognosis were compared between the two groups,and the influencing factors for frailty and death were analyzed.Results Faster heart rate,higher NT-proBNP level,and larger proportions of male,diabetes,coronary heart disease,≥5chronic diseases,LVEF≤35%,anemia and increased troponin I level,while lower BMI,eGFR and score of activity of daily living scale were observed in the frailty group than the non-frailty group(P<0.05,P<0.01).The frail group had significantly lower utilization rates of angiotensin converting enzyme inhibitors(ACEI),angiotensin receptor blockers(ARB),angiotensin receptor enkephalin inhibitors(ARNI),βreceptor blockers,and sodium-glucose cotransporter 2inhibitors than the non-frailty group(P<0.01).Additionally,the frailty group exhibited a higher incidence of emergency room visits/readmissions within 3months and 2-year mortality than the non-frailty group(P<0.05,P<0.01).Binary logistic regression analysis revealed that≥5chronic diseases,LVEF≤35%,BMI,and GFR were independent risk factors for frailty(OR=0.167,95%CI:0.064-0.453,P=0.000;OR=0.306,95%CI:0.160-0.586,P=0.000;OR=0.868,95%CI:0.786-0.958,P=0.005;OR=0.966,95%CI:0.943-0.991,P=0.007),while≥5chronic diseases and frailty were independent risk factors for death in HF patients(P<0.05).Conclusion The incidence of frailty is high in elderly HF patients with HFrEF.They have poor compliance to guideline directed drug therapy(GDMT).Frailty is an independent risk factor for long-term mortality in the patients.
作者
宗敏
关晓楠
常晶
张建军
Zong Min;Guan Xiaonan;Chang Jing;Zhang Jianjun(Heart Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing100043,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第5期523-526,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
心肌梗死
休克
心源性
危险因素
心力衰竭
衰弱
myocardial infarction
shock,cardiogenic
risk factors
heart failure
frailt
