Influence Of Frailty On The Short-term Prognosis Of Elderly Patients With Heart Failure

ObjectiveFrailty is considered one of the most important problems associated with aging.The incidence of frailty is not identical,depending on the diagnostic criteria and the situation in different countries around the world.With the deepening of aging in China,the problems of cardiopulmonary insufficiency and frailty syndrome in the elderly are becoming more and more serious.Therefore,this study collected the general sociological data,related disease characteristics and laboratory examinations of hospitalized elderly patients with heart failure,analyzed the correlation between the above-mentioned frailty and heart failure,and explored the effect of frailty on the short-term prognosis of elderly patients with heart failure.MethodsProspectively collect clinical data of HF patients hospitalized in the Department of Cardiology and Geriatrics of the Second Affiliated Hospital of Shenyang Medical College from August 2020 to December 2021,including 1.General sociological data:gender,age,height,weight,body mass index,independent living or not,smoking history;2.diseases history:history of myocardial infarction,diabetes,hypertension,hyperlipidemia,atrial fibrillation,cerebrovascular disease;3.laboratory test results and echocardiographic indicators;4.Types of heart failure and NYHA;5.A six-minute walk test.The patients were divided into non-frailty group and frailty group according to whether they were of frailty.The two groups of patients were followed up.Build database.According to the type of heart failure,the patients were divided into heart failure group with reduced ejection fraction,heart failure group with preserved ejection fraction and heart failure group with intermediate ejection fraction,and the detection rate of frailty under different ejection fractions was compared;The patients were divided into frailty group and non-frailty group with or without frailty.The normally distributed measurement data were expressed as`X±S,and the comparison between groups was performed by t-test;the non-normally distributed measurement data was used as the median（quartile）The nonparametric test was used for comparison between groups;the enumeration data was expressed as percentage（%）,and theχ~2 test was used to compare the differences between groups;the re-hospitalization of patients with cardiovascular and cerebrovascular diseases or all-cause death within 10 months of follow-up was used as the combined end point.No end point events during the follow-up period were defined as censoring,and multivariate Cox regression analysis was used to analyze the effect of frailty on the readmission rate or fatality rate of elderly patients with heart failure.P<0.05was considered statistically significant.Results1.A total of 125 patients were included in the early stage of this study,including 48in the frail group and 73 in the non-frail group.4 patients were lost to follow-up,totaling121 patients,with a loss-to-follow-up rate of 3.2%.The detection rate of frailty was39.7%.2.Comparison of general data of research subjects:There were significant differences between the frail group and the non-frail group in gender,history of atrial fibrillation,New York heart function classification,and 6-minute walk test（P<0.05）.There were no significant differences in age,heart rate,independent living,smoking history,myocardial infarction history,hypertension history,hyperlipidemia history,diabetes history and cerebrovascular disease history between the two groups（P>0.05）.3.Differences in laboratory examination indexes of research subjects:There were statistical differences in hemoglobin,albumin,e GFR,NT-pro BNP and left atrial diameter between the frail group and the non-frail group（P<0.05）.There were no differences in BMI,aspartate aminotransferase,alanine aminotransferase,total cholesterol,triglyceride,low-density lipoprotein,high-density lipoprotein,interventricular septum thickness,left ventricular thickness,ejection fraction,diastolic dysfunction,and type of heart failure in both groups.Statistical difference（P>0.05）.4.During the follow-up period（median follow-up time of 10 months）,a total of 47cases（38.8%）of combined endpoint events occurred,including 28 cases（58.3%）in the frail group and 19 cases（26.0%）in the non-frail group.A total of 4 patients（3.3%）died due to cardiovascular and cerebrovascular reasons,including 2 patients（4.2%）in the frail group and 2 patients（2.7%）in the non-frail group.Forty-five patients（37.2%）were readmitted due to cardiovascular and cerebrovascular diseases,including 27（56.3%）in the frail group and 18（37.5%）in the non-frail group.Multivariate Cox analysis showed that the frail group had a 3.29-fold increased risk of readmission or death within 10months（P=0.003,95%Cl:1.50,7.21）;elderly patients living alone had an increased risk of readmission or death within 10 months 2.39 times（P=0.031,95%Cl:1.082,5.283）.5.According to the left ventricular ejection fraction,the patients were divided into three groups:HFr EF,HFmr EF,and HFp EF.There were 16 patients with HFr EF and 8patients with frailty,and the detection rate of frailty was 50%.There were 13 patients with HFmr EF and a total of 13 patients with frailty.5 patients,the detection rate of frailty was 38.5%;a total of 92 patients with HFp EF,and a total of 35 patients with frailty,the detection rate of frailty was 38.0%.Frailty increases with decreased ejection fraction in patients with heart failure.6.According to the age of the patients,the patients were divided into 65-74 years old group,75-84 year old group,and 85 years old and above group;there were 54 patients in the 65-74 year old group,and 19 patients with frailty,and the detection rate of frailty was 35.2%;40 people in the 75-84-year-old group,including 17 frail patients,with a frailty detection rate of 42.5%;27 people in the 85-year-old group,including 12 frail patients,with a frailty detection rate of 44.4%.The detection rate of frailty in patients with heart failure increases with age.Conclusion1.Frailty and independent living increase the short-term poor prognosis of elderly patients with heart failure.2.HFr EF patients are more prone to frailty than HFmr EF and HFp EF patients.