住院老年心房颤动患者发生衰弱的影响因素及对短期预后的影响

Influencing factors for frailty and their effects on short-term prognosis in elderly inpatients with atrial fibrillation

目的探讨住院老年心房颤动(房颤)患者的衰弱状态、影响因素及对短期预后的影响。方法回顾性分析2018年8月至2022年11月民航总医院老年科住院的老年房颤患者298例,根据FRAIL量表分为衰弱组154例和非衰弱组144例,比较2组临床指标和老年综合评估结果,随访30d和90d内再住院和全因死亡情况,分析发生衰弱的影响因素和对短期预后的影响。结果298例患者中,衰弱发生率为51.7%。与非衰弱组比较,衰弱组年龄、住院时间、心力衰竭、慢性肾脏病、B型钠尿肽、Barthel指数≤60分、营养风险筛查量表2002评分≥3分、共病指数≥6分、房颤负荷、CHA2DS2-VASc评分和左心室舒张末期内径明显增高,血红蛋白、估算的肾小球滤过率、白蛋白、抗凝治疗比例明显降低,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,年龄、住院时间、心力衰竭是老年房颤患者发生衰弱的危险因素(OR=1.099,95%CI:1.040~1.161,P=0.001;OR=2.178,95%CI:1.724~2.751,P=0.001;OR=2.186,95%CI:1.008~4.739,P=0.048),白蛋白是老年房颤患者发生衰弱的保护因素(OR=0.802,95%CI:0.706~0.911,P=0.001)。衰弱组30d和90d内再入院率明显高于非衰弱组(11.0%vs4.2%,P=0.026;16.9%vs6.9%,P=0.009)。结论年龄大、住院时间长、合并心力衰竭和低白蛋白水平的住院老年房颤患者更容易发生衰弱,衰弱的老年房颤患者短期内再入院率更高。

Objective To investigate the frailty status,influencing factors and effects on short-term prognosis of hospitalized elderly patients with atrial fibrillation(AF).Methods A retrospective study was conducted on 298 elderly AF inpatients admitted to our department from August 2018 to November 2022.According to the FRAIL scale,they were divided into frail group(154 cases)and non-frail group(144 cases).The clinical data and results of geriatric comprehensive assessment were compared between the two groups,the readmission and all-cause death in 30 and 90 d after discharge were observed,and the influencing factors for frailty and effects on short-term prognosis were analyzed.Results Among the 298 patients,the incidence of frailty was 51.7%.When compared with the non-frail group,the frail group had older age,longer length of hospital stay,larger proportions of heart failure and chronic kidney disease,higher B-type natriuretic peptide level,elevated ratios of Barthel index≤60,nutritional risk screening scale 2002 score≥3,comorbidity index≥6 and CHA__(2)DS__(2)-VASc score,and higher AF burden and left ventricular end-diastolic diameter,while lower hemoglobin,estimated glomerular filtration rate,albumin,and proportion of anticoagulant treatment(P<0.01).Logistic regression analysis showed that age,length of hospital stay,and heart failure were risk factors for frailty in elderly AF patients(OR=1.099,95%CI:1.040-1.161,P=0.001;OR=2.178,95%CI:1.724-2.751,P=0.001;OR=2.186,95%CI:1.008-4.739,P=0.048),and albumin was a protective factor for frailty in them(OR=0.802,95%CI:0.706-0.911,P=0.001).The readmission rate within 30 and 90 d was higher in the frail group than the non-frail group(11.0%vs 4.2%,P=0.026;16.9%vs 6.9%,P=0.009).Conclusion Hospitalized elderly patients with AF who were older,longer in hospital stay,with heart failure and lower albumin level are prone to frailty,and those with frailty have higher rate of short-term readmission.