老年心房颤动住院患者合并衰弱的危险因素及预后分析

Risk factors and prognosis of frailty in elderly inpatients with atrial fibrillation

目的探究老年心房颤动(房颤)住院患者合并衰弱的危险因素及衰弱对预后的影响。方法本研究为前瞻性队列研究。选取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,应用老年综合评估衰弱指数(CGA-FI)进行衰弱评估,进行1年随访,主要研究终点为全因死亡或再入院。结果连续纳入≥65岁的老年房颤住院患者197例,年龄(77.52±7.11)岁,其中男113例(57.36%,113/197),符合CGA-FI标准的衰弱患者84例(42.6%,84/197),多因素Logistic回归分析表明年龄(OR=6.38,95%CI 2.49~16.37,P<0.001)、Charlson共病指数(OR=1.80,95%CI 1.09~2.99,P=0.021)、认知障碍(OR=7.37,95%CI 2.06~26.34,P<0.001)、营养不良(OR=147.40,95%CI 3.88~598.00,P<0.001)、≥7种口服药(OR=3.24,95%CI 1.14~9.20,P=0.030)与衰弱呈正相关。随访1年发生主要终点事件82例(41.6%,82/197),Kaplan-Meier生存曲线表明合并衰弱的老年房颤患者无事件生存率低于无衰弱者(Log-rank P=0.026)。结论增龄、共病、认知障碍、营养不良及多重用药是老年房颤住院患者合并衰弱的独立危险因素,衰弱会增加老年房颤住院患者全因死亡及再入院风险。

Objective To investigate the risk factors of frailty in elderly inpatients with atrial fibrillation(AF)and the impact of frailty on prognosis.Methods This study was a prospective cohort study.The elderly inpatients aged≥65 years with AF from Beijing Hospital,Chinese People′s Liberation Army General Hospital and Beijing Tsinghua Changgung Hospital from September 2018 to April 2019 were selected.Frailty was assessed using the comprehensive geriatric assessment frailty index(CGA-FI),and followed up for 1 year.The primary endpoint was all-cause death or rehospitalization.Results A total of 197 hospitalized elderly inpatients with AF were enrolled,age(77.52±7.11)years old,with 113 males(57.36%,113/197),and 84(42.6%,84/197)of them met the CGA-FI criteria for frailty.Multivariate Logistic regression analysis showed age(OR=6.38,95%CI 2.49-16.37,P<0.001),Charlson comorbidity index(OR=1.80,95%CI 1.09-2.99,P=0.02),congnitive impairment(OR=7.37,95%CI 2.06-26.34,P<0.001),malnutrition(OR=147.40,95%CI 3.88-598.00,P<0.001)and≥7 kinds of oral drugs(OR=3.24,95%CI 1.14-9.20,P=0.030)were positively correlated with frailty.During 1 year follow-up,82 patients(41.6%,82/197)had primary endpoint events.Kaplan-Meier survival curve showed event-free survival rate was significantly lower in elderly patients with AF complicated with frailty than without frailty(Log-rank P=0.026).Conclusion Aging,comorbidities,cognitive impairment,malnutrition and polypharmacy are independent risk factors for frailty in elderly inpatients with AF.Frailty increases the risk of all-cause mortality and rehospitalization in elderly inpatients with AF.