老年心房颤动住院患者衰弱评估及相关工具比较

Comparison of frailty assessment and related tools in elderly hospitalized patients with atrial fibrillation

目的观察老年心房颤动(房颤)住院患者衰弱评估及衰弱评估工具的相关性、一致性和诊断能力。方法前瞻性纳入2018年9月至2019年4月北京医院、中国人民解放军总医院和北京清华长庚医院年龄≥65岁老年房颤住院患者197例,应用临床衰弱分级(CFS)、FRAIL量表、Fried衰弱表型、EFS量表和老年综合评估衰弱指数(CGA-FI)5种衰弱工具进行衰弱筛查及评估。结果197例老年房颤住院患者年龄(77.5±7.1)岁,男性57.4%(113例),5种衰弱工具调查的衰弱患病率由低到高分别是FRAIL(25.4%,50例)、EFS(27.9%,55例)、Fried(34.5%,68例)、CFS(40.6%,80例)、CGA-FI(42.6%,84例)。CFS与CGA-FI具有良好的相关性(相关系数为0.80)和一致性(Kappa值为0.71,95%CI0.61~0.81),将联合衰弱指数作为衰弱诊断金标准,结果显示CFS和CGA-FI诊断敏感度高,分别为95.9%和98.0%,特异度分别77.7%和75.7%。结论衰弱在老年房颤住院患者中常见,呈多维度特征,体能衰弱并不突出。对房颤患者推荐使用CFS与CGA-FI进行衰弱评估,两者具有良好的相关性和一致性。

Objective We evaluated frailty in elderly hospitalized patients with atrial fibrillation and analyzed the relevance,consistency,and diagnostic power of different frailty tools.Methods From September 2018 to April 2019,a total of 197 elderly patients with atrial fibrillation aged≥65 years in Beijing Hospital,Chinese PLA General Hospital,and Beijing Tsinghua Changgung Hospital were prospectively enrolled.Five frailty tools,including the clinical frailty scale(CFS),FRAIL scale(FRAIL),Fried frailty phenotype(Fried),Edmonton frail scale(EFS),and comprehensive geriatric assessment-frailty index(CGA-FI),were used for frailty assessment.Results A total of 197 hospitalized elderly patients with atrial fibrillation were enrolled,with an average age of(77.5±7.1)years old(57.4%male).The prevalence of frailty,according to the five frailty tools,were 25.4%(FRAIL),27.9%(EFS),34.5%(Fried),40.6%(CFS),and 42.6%(CGA-FI),respectively.CFS had a good correlation(correlation coefficient 0.80)and and consistency(Kappa value 0.71,95%CI 0.61~0.81)with CGA-FI.The combined frailty index was used as the gold standard for frailty diagnosis.The results showed that CFS and CGA-FI had high diagnostic sensitivity(95.9%and 98.0%,respectively)and specificity(77.7%and 75.7%,respectively).Conclusions Frailty is common in elderly hospitalized patients with atrial fibrillation,showing multidimensional features,and physical weakness is not prominet.CFS and CGA-FI are recommended for the assessment of frailty in patients with atrial fibrillation,which had good correlation and consistency.