Objectives

This study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF).

Background

In contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF.

Methods

Older hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined.

Results

A total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85).

Conclusions

Ninety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.

中文翻译：

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失代偿的老年心力衰竭患者的虚弱：患病率，与以患者为中心的结果的关联以及有效的检测方法。

目标

这项研究旨在评估衰弱的患病率，其与身体功能，生活质量（QoL），认知和抑郁的相关性，并研究在住院治疗的急性失代偿性心力衰竭（ADHF）老年患者中更有效的检测方法。

背景

与患有慢性HF的门诊患者相反，对于年老住院的ADHF患者的虚弱知之甚少。

方法

住院的ADHF老年患者（N = 202）进行了脆弱性评估（使用弗里德准则），体能短电池（SPPB），6分钟步行测试（6-MWT）距离，生活质量（使用堪萨斯城心肌病的QoL）问卷），认知（使用蒙特利尔认知评估）和抑郁（使用老年抑郁症筛查[GDS]）。脆弱与这些以患者为中心的结果之间的关联通过使用调整后的线性回归模型进行了评估。研究了识别脆弱的新颖策略。

结果

总共有50％的老年ADHF住院患者虚弱，48％为虚弱，2％为非虚弱。女性，合并症的负担和先前的HF住院与身体虚弱的可能性更高相关。体弱（相对于体弱者之前的状态）与SPPB评分（分别为5±2.2 vs. 7±2.4），6-MWT距离（分别为143±79 m和221±99 m）明显更差（QoL）相关（分别为35±19和46±21）和更多的抑郁症（GDS评分：分别为5.5±3.5和4.2±3.3），但认知相似。在调整了年龄，性别，种族，总合并症和体重指数之后，这些关联没有改变。缓慢的步态速度加上低体力活动也表明身体虚弱（C统计量= 0.85）。

结论

老年住院的ADHF患者中有98％身体虚弱或虚弱。体弱（相对于体弱多病的状态）与身体机能，生活质量，合并症和抑郁症的恶化有关。简单的4米步行测试与自我报告的体育锻炼相结合，可以快速有效地识别老年ADHF患者的身体虚弱。