Prognostic value of geriatric conditions for death and bleeding in older patients with atrial fibrillation.
Prognostic value of geriatric conditions for death and bleeding in older patients with atrial fibrillation.
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老年病对老年心房颤动患者死亡和出血的预后价值。
DOI：
10.1016/j.ijcha.2021.100739
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
McManus DD
中科院分区：
文献类型：
--
作者：
Wang W;Lessard D;Saczynski JS;Goldberg RJ;Mehawej J;Gracia E;McManus DD
老年房颤（AF）患者普遍存在虚弱和认知障碍等老年性疾病。我们检查了老年疾病对预测这些患者1年死亡率和出血事件的预后价值。SAGE（老年要素系统评估）-房颤研究是一项多中心队列研究，招募了2016年至2018年间美国马萨诸塞州和佐治亚州65岁及以上房颤和CHA2DS2 -VASc评分为2分或更高的个体（平均年龄75岁，48%为女性，86%服用口服抗凝剂）。在基线时进行六项老年评估，包括虚弱、认知功能、社会支持、抑郁症状、视力和听力的有效测量。研究终点包括全因死亡率和临床相关出血。1年后，1097人（96.5%）参加了随访，44人（3.9%）死亡，56人（5.1%）有临床相关出血。在调整人口统计学和临床因素后，社会孤立（优势比[OR] 1.69, 95%可信区间[CI]: 1.01-2.84）、抑郁（优势比[OR] 1.94, 95% CI: 1.28-2.95）和虚弱（优势比[OR] 2.55, 95% CI: 1.55-4.19）与死亡或临床相关出血的综合终点显著相关。多变量调整后，抑郁（OR 1.79, 95% CI 1.09-2.93）和虚弱（OR 2.83, 95% CI 1.55-5.17）与临床相关出血显著相关。社会孤立、抑郁和虚弱是老年男性和女性房颤患者来年死亡或出现临床相关出血的预后因素。在这些患者的护理中，评估老年损伤值得考虑。
Geriatric conditions, such as frailty and cognitive impairment, are prevalent in older patients with atrial fibrillation (AF). We examined the prognostic value of geriatric conditions for predicting 1-year mortality and bleeding events in these patients. SAGE (Systematic Assessment of Geriatric Elements)-AF study is a multicenter cohort study which enrolled individuals (mean age 75 years, 48% women, 86% taking oral anticoagulation) 65 years and older with AF and CHA2DS2 -VASc score of 2 or higher from clinics in Massachusetts and Georgia, USA between 2016 and 2018. A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing was performed at baseline. Study endpoints included all-cause mortality and clinically relevant bleeding. At 1 year, 1,097 (96.5%) individuals attended the follow up visit, 44 (3.9%) had died, and 56 (5.1%) had clinically relevant bleeding. After adjustment for demographic and clinical factors, social isolation (odds ratio [OR] 1.69, 95% confidence interval [CI]: 1.01–2.84), depression (OR 1.94, 95% CI: 1.28–2.95) and frailty (OR 2.55, 95% CI: 1.55–4.19) were significantly associated with the composite endpoint of death or clinically relevant bleeding. After multivariable adjustment, depression (OR 1.79, 95% CI 1.09–2.93) and frailty (OR 2.83, 95% CI 1.55–5.17) were significantly associated with clinically relevant bleeding. Social isolation, depression, and frailty were prognostic of dying or experiencing clinically relevant bleeding during the coming year in older men and women with AF. Assessing geriatric impairments merits consideration in the care of these patients.
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