老年心血管病患者衰弱综合评估与强化教育对健康结局的影响

Effects of comprehensive evaluation of frailty and corresponding intensive education on health outcomes of elderly patients with cardiovascular disease

目的探讨衰弱综合评估与强化教育对老年心血管病住院及出院患者健康结局的影响。方法采用连续入组方式于2019年2月至5月选取解放军总医院心血管内科的老年心血管疾病住院患者100例,开展Fried衰弱表型及老年综合评估研究,并从多个时间节点进行强化教育并观察疗效。结果老年心血管疾病住院患者衰弱和不衰弱分别为24例和76例,logistic回归分析显示3米起立行走计时测试(OR=1.151,95%CI 1.029~1.288,P=0.014)、心绞痛(OR=8.510,95%CI 1.753~41.307,P=0.008)和D-二聚体(OR=2.925,95%CI 1.161~7.369,P=0.023)是衰弱的影响因素。研究未显示衰弱对心血管疾病住院患者的并发症有影响,且所有患者未发生死亡、跌倒与骨折等不良事件。衰弱和不衰弱患者在出院后6个月内有跌倒、骨折、再入院事件发生分别为9例和19例,差异无统计学意义(P>0.05)。2组患者出院后3个月抑郁评估得分均较住院时下降,长期口服药种类不衰弱组较住院时减少(P<0.05)。出院后6个月不衰弱组FRAIL衰弱评分及BMI指数均较住院时降低(P<0.05),衰弱组变化不显著。2组患者出院后与住院时基本日常生活活动量表(BADL)评分比较,差异均无统计学意义(P>0.05)。结论老年心血管病住院患者衰弱综合评估与强化教育有助于减少住院和出院后不良事件的发生,在改善患者出院后衰弱、抑郁、体质量指数及多重用药方面,不衰弱组比衰弱组效果显著。

Objective To investigate effects of comprehensive evaluation of frailty and corresponding intensive education on the health outcomes in the elderly patients with cardiovascular disease during hospitalization and after discharge.Methods A total of 100 consecutive elderly patients with cardiovascular disease were selected for the study,who were admitted to the Department of Cardiology of Chinese PLA General Hospital from February to September 2019.Fried frailty phenotype and comprehensive evaluation of the elderly were analyzed.Intensive education was conducted from multiple time points,and the efficacy was observed.Results Of all the included patients,24 had frailty and 76 did not.Logistic regression analysis of the factors affecting frailty showed that 3-meter timed up&go test(OR=1.151,95%CI 1.029-1.288,P=0.014),angina(OR=8.510,95%CI 1.753-41.307,P=0.008)and D-dimer(OR=2.925,95%CI 1.161-7.369,P=0.023)were risk factors of frailty.Our study showed that frailty had no effect on the complications in patients hospitalized with cardiovascular disease,and no adverse events such as death,falls,or fractures occurred in all patients.The incidence of falls,fractures and readmission within 6 months after discharge occurred in 9 frailty patients and 19 non-frailty patients without significant difference.The scores of depression assessment at 3 months after discharge in both groups were lower than that on hospitalization,and the number of long-term oral medicines was lower than that during hospitalization in the non-frailty group(P<0.05).The FRAIL score and BMI in the non-frail group decreased at 6 months after discharge compared with that during hospitalization(P<0.05),and the frailty group did not change significantly.There was no significant difference between the two groups in basic activities of daily living(BADL)score(P>0.05).Conclusion Comprehensive evaluation of frailty and corresponding intensive education in the elderly inpatients with cardiovascular disease contribute significantly to the reduction in the incidence of events after hospitalization and discharge,which has more significant effects on modifying frailty,depression,body mass index and multiple medication in the non-frailty group than in the frailty group.