Background:Older hospitalized acute decompensated heart failure (HF) patients have persistently poor outcomes and delayed recovery regardless of ejection fraction (EF). We hypothesized that impairments in physical function, frailty, cognition, mood, and quality of life (QoL) potentially contributing to poor clinical outcomes would be similarly severe in acute decompensated HF patients ≥60 years of age with preserved versus reduced EF (HFpEF and HFrEF).Methods and Results:In 202 consecutive older (≥60 years) hospitalized acute decompensated HF patients in a multicenter trial, we prospectively performed at baseline: short physical performance battery, 6-minute walk distance, frailty assessment, Geriatric Depression Scale, Montreal Cognitive Assessment, and QoL assessments. Older acute decompensated HFpEF (EF ≥45%, n=96) and HFrEF (EF <45%, n=106) patients had similar impairments in all physical function measures (short physical performance battery [5.9±0.3 versus 6.2±0.2]; 6-minute walk distance [184±10 versus 186±9 m]; and gait speed [0.60±0.02 versus 0.61±0.02 m/s]) and rates of frailty (55% versus 52%; P=0.70) and cognitive impairment (77% versus 81%; P=0.56) when adjusted for differences in sex, body mass index, and comorbidities. However, depression and QoL were consistently worse in HFpEF versus HFrEF. Depression was usually unrecognized clinically with 38% having Geriatric Depression Scale ≥5 and no documented history of depression.Conclusions:Patients ≥60 years hospitalized with acute decompensated HF patients have broad, marked impairments in physical function and high rates of frailty and impaired cognition: these impairments are similar in HFpEF versus HFrEF. Further, depression was common and QoL was reduced, and both were worse in HFpEF than HFrEF. Depression was usually unrecognized clinically. These findings suggest opportunities for novel interventions to improve these important patient-centered outcomes.Clinical Trial Registration:URL: https://www.clinicaltrials.gov. Unique identifier: NCT02196038.

中文翻译：

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≥60岁急性失代偿性心力衰竭并保留射血分数降低的住院≥60岁成年人的身体功能，虚弱，认知，抑郁和生活质量

背景：无论射血分数（EF）如何，老年住院的急性失代偿性心力衰竭（HF）患者的结局均较差且恢复延迟。我们假设，对于年龄≥60岁的急性失代偿性HF患者，EF保留相对于EF降低（HFpEF和HFrEF），可能导致不良临床结果的身体机能，虚弱，认知，情绪和生活质量（QoL）损害同样严重方法和结果：在一项多中心试验中，在202名连续（≥60岁）住院的急性失代偿性HF患者中，我们按基线进行了前瞻性研究：体能低下，步行6分钟，身体虚弱，老年抑郁量表，蒙特利尔认知评估和生活质量评估。老年急性失代偿性HFpEF（EF≥45％，n = 96）和HFrEF（EF <45％，P = 0.70）和认知障碍（分别为77％和81％；P= 0.56），根据性别，体重指数和合并症的差异进行调整。但是，与HFrEF相比，HFpEF的抑郁和生活质量一直较差。临床上通常无法识别出抑郁症，其中38％的老年抑郁量表≥5，无抑郁史。结论：住院≥60岁并患有急性失代偿性HF的患者身体功能明显受损，身体虚弱和认知障碍的发生率很高： HFpEF与HFrEF的这些损伤相似。此外，HFpEF的抑郁症很常见，QoL降低，两者均比HFrEF差。临床上通常不认识抑郁症。这些发现为采取新颖的干预措施以改善这些以患者为中心的重要结果提供了机会。临床试验注册：URL：https://www.clinicaltrials.gov。