Research On The Frailty Of Elderly With CHD And The Short Term Adverse Events

?Objective?To understand the current status of frailty in elderly with coronary heart disease(CHD),analyze the influencing factors of frailty and explore the effect of frailty on the short-term prognosis of elderly patients with CHD.?Methods?Methods of cross-sectional study and prospective study were used.All participants were from cardiovascular medical ward of two comprehensive first-class hospitals at the third level in Ji'nan City Shandong Province.260 participants with CHD were investigated with the general situation questionnaire,Activity of Daily Living Scale,5-Item Geriatric Depression Scale and Mini-Mental State Examination,Social Support Rating Scale and Fried Frailty Phentoype from April 2017 to June 2017.The effective recovery rate was 95.38% in 248 valid questionnaires collected.From October 2017 to December,248 elderly patients with CHD were followed up by telephone,supplemented by outpatient and inpatient follow-up,and clinical endpoint events were recorded such as death,irregular readmission,fall,recurrence of diseases outside hospital,etc.The database was established and the statistical analysis was carried out with SPSS 24.0 software.?Results? 1.In 248 Cases of elderly patients with CHD,79 patients were with frailty.The incidence of frailty and pre-frailty was respectively 31.85% and 25%.In the frailty index,the incidence of low grip strength and self-reporting exhaustion was 45% and 32% respectively.2.The results of the univariate analysis showed that: age,education level,monthly income,living style from demographic data were influencing factors of pre-frail and frail elderly patients with CHD(p<0.05),marital status was influential factor of frailty patients with CHD(p<0.05).Activities of daily life(ADL),cognition,depression from health status data were the influential factors of pre-frail and frail elderly(p<0.05).Self-assessment of health status was the influential factor of frailty patients with CHD(p<0.05).Coexistence of multiple diseases,multidrug combination,and Hemoglobin(HGB)were the influencing factors of pre-frail and frail elderly with CHD(p<0.05),NYHA,Platelet(PLT),Serum Albumin(ALB),and Total Protein(TP)were the influencing factors of frail elderly with CHD(p<0.05).The results of multivariate regression analysis showed that age and depression were independent influencing factors of pre-frail and frail elderly with CHD(p<0.05).Self-assessment of health status,ADL,cognitive function,NYHA and HGB were independent influencing factors in frailty elderly with CHD(p<0.05).3.The average score of the total score of social support for frail elderly with CHD was 37.06±4.99,which was lower than that of the non frail group with 41.38±4.69.There was a negative correlation between the score of frail and the utilization of social support and the total score of social support(R=-0.240,p<0.05;r=-0.261,p<0.05).The score of pre-frail period was negatively correlated with subjective support and total score of social support(R=-0.383,p<0.01;r=-0.291,p<0.05).It suggested that the higher the score of social support,the lower the score of frail and pre-frail.4.Follow-up Cox survival analysis showed that frailty was an independent risk factor among fall event(HR=6.108,95%CI 1.620 ~ 23.027),unconventional rehospitalization event(HR=3.77,95%CI 2.104 ~ 6.756),and recurrence of diseases outside the hospital(HR=2.898,95%CI 1.592~5.494)in frail elderly with CHD.?Conclusion? 1.The incidence of frailty elderly with CHD was 31.86%.Low grip strength was the main manifestation of frailty.Clinical medical staff should pay more attention to the problem of frail in elderly with CHD.Low grip strength was a powerful indication of frality.2.Age and depression were the common independent influencing factors of pre-frail and frail elderly patients with CHD.Self-assessment of health status,ADL,cognitive function,NYHA and HGB were the independent influencing factors of frail elderly with CHD.3.Compared with the non-frail group,frail patients with CHD had poor social support.The more serious the frailty was,the worse the social support was.4.According to the follow-up after 6 months,frailty was an independent risk factor of falling,rehospitalized unroutinely and recurrence of diseases outside the hospital for the elderly patients with CHD.