Background

To examine the individual and combined associations of non-cardiac-related conditions and mobility limitation with morbidity and mortality in adults with heart failure (HF).

Methods

We conducted a retrospective cohort study in a large, diverse group of adults with HF from five U.S. integrated healthcare delivery systems. We characterized patients with respect to the presence of non-cardiac conditions (<3 vs ≥3) and/or mobility impairment (defined by the use/nonuse of a wheelchair, cane, or walker), categorizing them into four subgroups. Outcomes included all-cause death and hospitalizations for HF or any cause.

Results

Among 114,553 adults diagnosed with HF (mean age: 73 years old, 46% women), compared with <3 non-cardiac conditions/no mobility limitation, adjusted hazard ratios (HR) for all-cause death among those with <3 non-cardiac conditions/mobility limitation, ≥3 non-cardiac conditions/no mobility limitation, ≥3 non-cardiac conditions/mobility limitation (vs.) were 1.40 (95% CI, 1.31-1.51), 1.72 (95% CI, 1.69-1.75), and 1.93 (95% CI, 1.85-2.01), respectively. We did not observe an increased risk of any-cause or HF-related hospitalization related to the presence of mobility limitation among those with a greater burden of non-cardiac multimorbidity. Consistent findings regarding mortality were observed within groups defined according to age, gender, and HF type (preserved, reduced, mid-range ejection fraction), with the most prominent impact of mobility limitation in those <65 years of age.

Conclusions

There is an additive association of mobility limitation, beyond the burden of non-cardiac multimorbidity, on mortality for patients with HF, and especially prominent in younger patients.

中文翻译：

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与心力衰竭的老年人无关的与心脏病相关的发病率，活动受限和结局

背景

研究非心脏相关疾病和活动受限与心力衰竭（HF）成人发病率和死亡率的个体和综合关联。

方法

我们对来自五个美国综合医疗保健提供系统的大量不同的HF患者进行了回顾性队列研究。我们针对患者的非心脏疾病（<3 vs≥3）和/或行动不便（由使用/不使用轮椅，拐杖或助行器定义）进行了分类，将其分为四个亚组。结果包括因HF或任何原因导致的全因死亡和住院。

结果

在114,553名被诊断患有HF的成年人中（平均年龄：73岁，女性占46％），与<3个非心脏疾病/无行动障碍的人相比，<3个非心脏病患者的全因死亡调整后的危险比（HR）心脏疾病/活动性限制，≥3非心脏疾病/无活动性限制，≥3非心脏疾病/运动性限制（vs.）为1.40（95％CI，1.31-1.51），1.72（95％CI，1.69- 1.75）和1.93（95％CI，1.85-2.01）。我们没有观察到在非心脏多发性疾病负担较大的人群中，由于行动不便而导致因任何原因或与HF相关的住院风险增加。 在根据年龄，性别和心力衰竭类型（保留，降低的中程射血分数）定义的组中，观察到了与死亡率一致的发现，在那些<65岁的人群中，行动受限的影响最为显着。

结论

除非心脏多发性疾病的负担外，行动不便的限制与心衰患者的死亡率有关，在年轻患者中尤为突出。