Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE-HF Registry Subanalysis.
Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE-HF Registry Subanalysis.
复制标题
社会脆弱对住院老年心力衰竭患者的影响：一项FRAGILE-HF登记亚组分析。
DOI：
10.1161/jaha.120.019954
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发表时间：
2021-09-07
影响因子：
5.4
通讯作者：
Matsue Y
中科院分区：
文献类型：
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作者：
Jujo K;Kagiyama N;Saito K;Kamiya K;Saito H;Ogasahara Y;Maekawa E;Konishi M;Kitai T;Iwata K;Wada H;Kasai T;Nagamatsu H;Ozawa T;Izawa K;Yamamoto S;Aizawa N;Yonezawa R;Oka K;Makizako H;Momomura SI;Matsue Y
虚弱被概念化为多个领域缺陷的累积，并与心力衰竭（HF）的预后密切相关。然而，社会领域的脆弱性研究较少。我们前瞻性地评估了老年心力衰竭患者的社会脆弱性（SF）的临床特征和预后影响。FRAGILE‐HF（因心力衰竭住院的老年患者身体和社会脆弱的患病率和预后价值）是一项多中心、前瞻性队列研究，重点关注因HF住院且年龄≥65岁的患者。我们用Makizako的5个项目定义SF，这些项目已被证实与未来残疾相关。主要终点是全因死亡和因HF再次住院的复合终点。还评价了SF对全因死亡率的影响。在1240例入组患者中，825例（66.5%）患有SF。在出院后1年的观察期内，SF患者的联合终点和全因死亡率显著高于无SF患者（Log-rank检验：均P < 0.05）。SF与联合终点（风险比，1.30; 95%CI，1.02-1.66; P = 0.038）和全因死亡率（风险比，1.53; 95%CI，1.01-2.30; P = 0.044）显著相关，即使在调整关键临床风险因素后也是如此。此外，SF在联合终点（净重新分类改善：0.189，95% CI，0.063-0.316，P = 0.003）和全因死亡率（净重新分类改善：0.234，95% CI，0.073-0.395，P = 0.004）方面显示出相对于已知风险因素的显著增量预后价值。在住院的老年HF患者中，三分之二患有SF。评估SF可为老年HF患者提供额外的预后信息。网址：https://upload.umin.ac.jp/。唯一标识符：UMIN 000023929。
Frailty is conceptualized as an accumulation of deficits in multiple areas and is strongly associated with the prognosis of heart failure (HF). However, the social domain of frailty is less well investigated. We prospectively evaluated the clinical characteristics and prognostic impact of social frailty (SF) in elderly patients with HF. FRAGILE‐HF (prevalence and prognostic value of physical and social frailty in geriatric patients hospitalized for heart failure) is a multicenter, prospective cohort study focusing on patients hospitalized for HF and aged ≥65 years. We defined SF by Makizako’s 5 items, which have been validated as associated with future disability. The primary end point was a composite of all‐cause death and rehospitalization because of HF. The impact of SF on all‐cause mortality alone was also evaluated. Among 1240 enrolled patients, 825 (66.5%) had SF. During the 1‐year observation period after discharge, the rates of the combined end point and all‐cause mortality were significantly higher in patients with SF than in those without SF (Log‐rank test: both P < 0.05). SF remained as significantly associated with both the combined end point (hazard ratio, 1.30; 95% CI, 1.02–1.66; P = 0.038) and all‐cause mortality (hazard ratio, 1.53; 95% CI, 1.01–2.30; P = 0.044), even after adjusting for key clinical risk factors. Furthermore, SF showed significant incremental prognostic value over known risk factors for both the combined end point (net‐reclassification improvement: 0.189, 95% CI, 0.063–0.316, P = 0.003) and all‐cause mortality (net‐reclassification improvement: 0.234, 95% CI, 0.073–0.395, P = 0.004). Among hospitalized geriatric patients with HF, two thirds have SF. Evaluating SF provides additive prognostic information in elderly patients with HF. URL: https://upload.umin.ac.jp/. Unique identifier: UMIN000023929.