老年心力衰竭病人衰弱危险因素的Meta分析

Meta-analysis of risk factors for frailty in elderly patients with heart failure

目的:通过Meta分析明确老年心力衰竭病人衰弱的危险因素,为后期老年心力衰竭病人衰弱的干预提供科学依据。方法:系统检索PubMed、CINAHL、Web of Science、the Cochrane Library、中国知网、万方数据知识服务平台、维普网,纳入关于老年心力衰竭病人衰弱危险因素的研究,检索时间限定为建库至2023年2月28日。由2名系统评价研究员严格按照纳入和排除标准独立筛选文献、评价纳入研究的偏倚风险以及提取数据资料,由第三方对研究分歧进行判断,采用RevMan 5.3软件进行Meta分析。结果:最终纳入16篇文献,其中1篇病例对照研究,15篇横断面研究。心力衰竭病人合计3 622例,其中衰弱病人2 401例,涉及影响因素10个。Meta分析结果显示,老年心力衰竭病人衰弱发生率为63%[95%CI(0.53,0.73),P<0.001],老年心力衰竭病人衰弱的危险因素为年龄[OR=1.14,95%CI(1.04,1.25),P<0.01]、心功能分级[OR=2.70,95%CI(1.57,4.64),P<0.01]、多重用药[OR=2.40,95%CI(1.42,4.04),P<0.01]、左心房内径[OR=2.05,95%CI(1.91,2.20),P<0.01]。敏感性分析显示,血肌酐、射血分数、共病指数及血红蛋白在两种模型下合并效应量有变化,存在发表偏倚。结论:老年心力衰竭病人的衰弱发生率较高,影响因素较多。应针对衰弱相关危险因素进行早期评估与干预,以减少衰弱对心力衰竭病人的不良影响,提高心力衰竭病人生活质量。

Objective:To identify the risk factors of frailty in elderly patients with heart failure through a Meta-analysis,and provide scientific basis for interventions to prevent frailty in elderly patients with heart failure.Methods:The studies on risk factors of frailty in elderly patients with heart failure were systematically searched from PubMed,CINAHL,Web of Science,the Cochrane Library,China National Knowledge Infrastructure,WanFang Data and VIP.The retrieval period was from establishment of databases to February 28,2023.Two independent reviewers screened the literature,evaluated the bias risk of the included studies,and extracted data according to inclusion and exclusion criteria.A third party judged the research differences.RevMan 5.3 software was used for Meta-analysis.Results:Sixteen studies were finally included,including one case-control study and 15 cross-sectional studies.A total of 3622 heart failure patients were included,of which 2401 were frail,involving 10 influencing factors.Meta-analysis results showed that the incidence of frailty in elderly patients with heart failure was 63%[95%CI(0.53,0.73),P<0.001],and the risk factors for frailty in elderly patients with heart failure were age[OR=1.14,95%CI(1.04,1.25),P<0.01],New York Heart Association cardiac functional grading[OR=2.70,95%CI(1.57,4.64),P<0.01],polypharmacy[OR=2.40,95%CI(1.42,4.04),P<0.01],and left atrial diameter[OR=2.05,95%CI(1.91,2.20),P<0.01].Sensitivity analysis showed changes in combined effects of serum creatinine,ejection fraction,Charlson Comorbidity Index,and hemoglobin under two models,publication bias was significant.Conclusions:The incidence of frailty in elderly heart failure patients is high and there are many influencing factors.Early assessment and intervention should be carried out for frailty-related risk factors to reduce the adverse effects of frailty on heart failure patients and improve their quality of life.