| Objective:The aim of this study was to investigate the effects of frailty on body mass index(BMI),blood biochemical parameters,quality of life,cardiac structure and function and safety in elderly patients with chronic heart failure(CHF)and Type 2 diabetes mellitus(T2DM)treated with dapagliflozin.Methods:A total of 100 elderly patients with CHF and T2DM admitted to the department of Geriatrics and Department of Cardiovascular Medicine,Yijishan Hospital,the first affiliated hospital of Wannan Medical College from March 2021 to March 2022 were selected,patients were divided into Frailty group(N=48)and non-Frailty group(N=52)according to the Frail scale.Patients in both groups were given standard anti-heart failure and hypoglycemic therapy according to clinical guidelines,and dapagliflozin was added on the basis(10mg,once a day).Body mass index(BMI),blood biochemical indexes,cardiac structure and function indexes,Kansas City cardiomyopathy questionnaire(KCCQ),6-minute walk distance(6MWD)and adverse reactions were compared between the two groups before and after treatment.Results:1.The incidence of frailty in elderly patients with chronic heart failure and diabetes mellitus was 48.0%,and the average score was 3.73.At baseline,there was no significant difference between the two groups in the clinical data of combined diseases,previous medication,BMI,blood biochemical indexes and cardiac structural indexes(P>0.05).There were significant differences in B-type natriuretic peptide(BNP),KCCQ score and 6-minute walking distance(6MWD)between the two groups(P<0.05).2.After 6 months treatment,the BMI of the patients in the frailty group did not decrease significantly(P>0.05),but the weight and BMI of the patients in the non-frailty group decreased significantly(P<0.05).3.After 6 months of treatment,the levels of fasting blood glucose(FBG),Glycated hemoglobin acid(HbA1c)and uric acid(UA)in both groups were significantly improved as compared with those before treatment(P<0.05),however,there was no significant difference in glomerular filtration rate(eGFR)before and after treatment(P>0.05),and there was no significant difference in FBG,HbAlc,UA and eGFR between the two groups after treatment(P>0.05).4.After 6 months of treatment,left ventricular end-diastolic diameter(LVEDD)in both groups was no significantly different from that before treatment(P>0.05),but left ventricular ejection fraction(LVEF),BNP,KCCQ score and 6MWD were improved,LVEF,BNP,KCCQ score and 6MWD were improved more significantly in the nonfrailty group than in the frailty group after treatment(P<0.05).5.During the course of treatment,there was no significant difference in the incidence of adverse reactions such as hypoglycemia between the two groups(P>0.05),but the incidence of urinary tract infection and readmission in the frailty group was higher than that in the non-frailty group(P<0.05).Conclusion:1.The addition of dapagliflozin to standard anti-heart failure treatments can improve blood glucose levels,heart structure and function,quality of life,and exercise tolerance in frail elderly patients with heart failure and diabetes.2.Frailty has no negative effect on cardiac structure and function,quality of life,activity tolerance,body mass index,blood glucose and other indicators in elderly patients with heart failure and diabetes mellitus treated with dapagliflozin,but the incidence of urinary tract infection and readmission rate in frailty group are higher than those in nonfrailty group.Dapagliflozin is safe and effective in elderly patients with frailty,but attention should be paid to the risk of urinary tract infection. |
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