住院老年冠心病患者合并衰弱的患病率及影响因素研究

Cross-sectional Study on the Prevalence of Frailty and Associated Risk Factors in Hospitalized Elderly Patients With Coronary Artery Disease

目的:分析住院老年冠心病患者合并衰弱的患病率及其影响因素。方法:连续入选2017年12月至2018年12月间年龄≥65岁、在北京协和医院老年医学科及心内科住院治疗的冠心病患者364例。运用老年综合评估评价患者的并存疾病及老年综合征,其中衰弱的评估采用临床衰弱评分。采用Logistic回归分析老年冠心病患者合并衰弱的影响因素。结果:364例入选老年冠心病患者中,合并衰弱者87例(23.9%)。合并衰弱患者与非衰弱患者相比,合并衰弱患者的年龄更大[(79.33±6.14)岁vs(73.11±5.79)岁,P<0.001],男性比例较低(46.0%vs 64.3%,P=0.002),患急性冠状动脉综合征比例较低(18.4%vs 30.3%,P=0.030),Charlson共病指数更高(2.17±1.63 vs 1.25±1.20,P<0.001),长期用药种类更多[(8.01±3.24)种vs(6.90±2.90)种,P=0.003],住院天数更长[(14.07±8.49)天vs(11.84±7.58)天,P=0.034],营养不良(8.0%vs 1.8%,P=0.012)、尿失禁(41.4%vs 16.6%,P<0.001)、1年内跌倒史(39.1%vs 23.1%,P=0.003)的比例更高。多因素Logistic回归分析显示,年龄(β=0.069,SE=0.030,P=0.020)、步速(β=-4.445,SE=0.953,P<0.001)、不能完成全足距测试(β=1.428,SE=0.365,P<0.001)、简易营养评估量表(MNA-SF)评分(β=-0.187,SE=0.086,P=0.029),以及Charlson共病指数(β=0.338,SE=0.132,P=0.010)均是老年冠心病患者合并衰弱的影响因素。结论:住院老年冠心病患者合并衰弱患病率较高。衰弱受年龄、步速、不能完成全足距测试、MNA-SF评分以及Charlson共病指数等因素影响,临床医师应重视老年冠心病患者功能状态的评估以及对合并老年综合征及共病的识别与管理。

Objective:To determine the prevalence of frailty among elderly patients with coronary artery disease and search for related clinical factors.Methods:A total of 364 hospitalized elderly patients diagnosed with coronary artery disease from geriatrics and cardiology department,Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled in the study.A comprehensive geriatric assessment was performed to evaluate the existing comorbidity and geriatric syndromes of the patients.Frailty was assessed using the Clinical Frailty Scale.The patients were classified as frail and non-frail,according to the scale.Logistic regression analysis was used to analyze the influencing factors of frailty for elderly patients with coronary artery disease.Results:There were 87 frail patients(23.9%)among the 364 hospitalized elderly patients diagnosed with coronary artery disease in the study.The frail patients were much older([79.33±6.14]years old vs[73.11±5.79]years old,P<0.001),proportion of male patients(46.0%vs 64.3,P=0.002)and acute coronary syndrome was lower(18.4%vs 30.3%,P=0.030)in frail patients as compared with those non-frail patients.There were more comorbid conditions(2.17±1.63 vs 1.25±1.20,P<0.001),higher proportion of polypharmacy(8.01±3.24 vs 6.90±2.90,P=0.003),and longer hospitalization([14.07±8.49]days vs[11.84±7.58]days,P=0.034)in frail patients as compared to those of non-frail patients.There were also higher proportion of malnutrition(8.0%vs 1.8%,P=0.012),urinary incontinence(41.4%vs 16.6%,P<0.001),history of falls(39.1%vs 23.1%,P=0.003)in frail patients as compared to non-frail patients.Stepwise multivariate binary logistic regression analysis revealed that older age(β=0.069,SE=0.030,P=0.020),low walking speed(β=-4.445,SE=0.953,P<0.001),unable to accomplish full tandem stance(β=1.428,SE=0.365,P<0.001),low MNA-SF score(β=-0.187,SE=0.086,P=0.029),and high Charlson comorbidity index(β=0.338,SE=0.132,P=0.010)were risk factors of frailty among elderly patients with coronary artery disease.Conclusions:Prevalence of frailty is high among hospitalized elderly patients with coronary artery disease.Frailty is influenced by age,walking speed,unable to accomplish full tandem stance,MNA-SF score and Charlson comorbidity index.Clinicians should give close attention to the recognition and management of functional status,geriatric syndromes,and comorbid conditions for elderly patients with coronary artery disease.