| Objective To screen the incidence of frailty and sarcopenia in elderly hospitalized patients with chronic heart failure（CHF）,evaluating the efficacy of exercise training and nutritional support combined with standard heart failure therapy on frailty in elderly patients with CHF,and the improvement of cardiac function.Methods A total of 200 elderly patients with CHF who were hospitalized in Hangzhou Third People’s Hospital from January 2020 to March 2021 were selected as the research objects.Muscle mass of the 200 patients was measured by InbodyS10 body composition analyzer,using appendicular muscle mass index（appendicular muscle mass/height2）,grip strength and Six-Minute Walking Test（step speed）as diagnostic criteria to screen out patients who with sarcopenia,and then compared the sarcopenia index of CHF patients with sarcopenia and those without sarcopenia.Fried frailty syndrome criteria were used to screen 200 selected patients for frailty,the cardiac function was compared between the frailty group and the non-frailty group,according to the NYHA cardiac function grading,echocardiographic left ventricular ejection fraction（LVEF）,serum N-terminal prohormone of Brain Natriuretic Peptide（NT-proBNP）levels and six-minute walking distance.Then,the 53 screened CHF patients complicated with frailty were divided into control group（27 cases）and observation group（26 cases）by the random number table method to intervene respectively.The control group received standard heart failure therapy including β-blockers,angiotensin converting enzyme inhibitors/angiotensin receptor inhibitors,aldosterone receptor antagonists and diuretic,the observation group was supplemented with exercise training and nutrition support on the basis of control group’s drug therapy.Both groups were treated for two months,after that,Fried frailty syndrome criterion was used again to evaluate the frailty of patients in both groups,and observe the severity of heart failure of two groups,then comparing the improvement of frailty before and after treatment and the effect of frailty improvement on cardiac function between the two groups.Results In our study,the incidence of elderly CHF patients complicated with frailty was 26.5%,and incidence of combined with sarcopenia was 31%.The relative risk of elderly CHF inpatients with sarcopenia for frailty was 4.328,the 95%confidence interval was 2.670 to 7.016,which compared with who without sarcopenia.The difference of sarcopenia index（appendicular muscle mass,six-minute walking distance and grip strength）between elderly CHF patients with sarcopenia and who without sarcopenia was statistically significant（P<0.05）.The cardiac function in elderly CHF patients complicated with frailty was worse than that in CHF patients without frailty:the former’s serum NT-proBNP levels were higher,the LVEF was lower and the proportion of Ⅲ in NYHA cardiac function grading was more,the six-minute walking distance was also shorter（P<0.05）.Our research results before and after intervention in elderly CHF patients with frailty show that,before treatment,the number of frailty patients in the observation group and the control group was 26 vs.27（cases）,after treatment,the number of frailty patients in the observation group and the control group was 15（57.69%）vs.23（85.19%）,the number of frailty in the observation group was less than that in the control group,and the difference was statistically significant（P<0.05）.Before treatment,there were no significant differences in serum NT-proBNP levels,LVEF,NYHA cardiac function grades and six-minute walking distance between two groups（P>0.05）.After treatment,the above indexes in observation group were improved compared with those before treatment（P<0.05）,while in the control group,the above indexes were improved except NYHA cardiac function grades（P<0.05）,moreover,the LVEF,NYHA cardiac function grades and six-minute walking distance of the observation group were better than those of the control group after treatment,and the differences were statistically significant（P<0.05）.Conclusion The incidence of frailty and sarcopenia was high in elderly inpatients with CHF,and sarcopenia is a relative risk factor for frailty.Elderly CHF patients with sarcopenia have worse physical function than who without sarcopenia.Elderly CHF patients combined with frailty had worse cardiac function than those without frailty.Exercise training and nutritional support combined with standard heart failure therapy can improve frailty in elderly CHF patients,and the improvement of frailty is beneficial to the improvement of cardiac function. |
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