Impact of Adverse Health Conditions on Clinical Outcomes of Older People with Atrial Fibrillation: Insights from a Prospective Cohort Study

IF 3.6 3区医学 Clinical Interventions in Aging Pub Date : 2024-09-06 DOI:10.2147/cia.s464044

Jun-Peng Liu, Yatong Zhang, Zinan Zhao, Tianqi Zhang, Yifan Na, Yao Luo, Yuhao Wan, Ning Sun, Cheng Wu, Hua Wang, Jiefu Yang

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Abstract

Objective: To evaluate the impact of adverse health conditions, including multimorbidity, frailty, malnutrition, cognitive impairment, and polypharmacy, on clinical outcomes in older people with atrial fibrillation (AF).
Patients and Methods: This prospective cohort study focused on patients aged 65 years and older with AF. They were admitted to the hospital between September 2018 and April 2019 and followed up for 1 year. We evaluated these participants for adverse health conditions including multimorbidity, frailty, malnutrition, cognitive impairment, and polypharmacy. The primary clinical outcome measured was a combination of all-cause mortality or rehospitalization.
Results: 197 older patients (≥ 65 years) with AF (mean age, 77.5± 7.1 years; 57.4% men) were enrolled. During 1-year follow-up, Primary endpoint events (all-cause mortality or rehospitalization) occurred in 82 patients (41.6%). Compared with the non-event group, the Charlson comorbidity index (CCI) was higher (2.5± 1.9 vs 1.7± 1.3, p=0.004), more heart failure (32.9% vs 17.4%, p=0.01) and chronic kidney disease (17.1% vs 7.0%, p=0.03), with lower systolic blood pressure (125.3± 18.3 mmHg vs 132± 17.9 mmHg, p=0.005) in the event group. On multivariate Cox regression showed that the CCI was associated with a higher odds ratio of the composite outcome of all-cause mortality and rehospitalization (HR: 1.26; 95% CI: 1.02– 1.56, p=0.03). Other adverse health conditions showed no significant association with the composite outcome of all-cause mortality and rehospitalization.
Conclusion: Among adverse health conditions in older people with AF, multimorbidity appears to be a significant determinant of adverse clinical outcomes.
Clinical Trial Registration: ChiCTR1800017204; date of registration: 07/18/2018.

Keywords: atrial fibrillation, older people, multimorbidity, prognosis

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不良健康状况对心房颤动老年人临床结局的影响：前瞻性队列研究的启示

目的评估不良健康状况（包括多病、虚弱、营养不良、认知障碍和多重用药）对心房颤动（房颤）老年人临床预后的影响：这项前瞻性队列研究主要针对 65 岁及以上的房颤患者。他们于 2018 年 9 月至 2019 年 4 月期间入院，随访 1 年。我们对这些参与者的不良健康状况进行了评估，包括多病、虚弱、营养不良、认知障碍和多重药物治疗。测量的主要临床结果是全因死亡率或再住院率：共纳入 197 名老年房颤患者（≥ 65 岁）（平均年龄为 77.5±7.1 岁；57.4% 为男性）。在为期一年的随访中，82名患者（41.6%）发生了主要终点事件（全因死亡或再次住院）。与非事件组相比，事件组的夏尔森合并症指数（CCI）较高（2.5± 1.9 vs 1.7±1.3，P=0.004），心衰（32.9% vs 17.4%，P=0.01）和慢性肾病（17.1% vs 7.0%，P=0.03）较多，收缩压较低（125.3± 18.3 mmHg vs 132± 17.9 mmHg，P=0.005）。多变量 Cox 回归显示，CCI 与全因死亡率和再次住院的复合结果的较高几率相关（HR：1.26；95% CI：1.02- 1.56，P=0.03）。其他不良健康状况与全因死亡率和再次住院的综合结果无明显关系：结论：在心房颤动老年人的不良健康状况中，多重疾病似乎是不良临床结局的重要决定因素：临床试验注册：ChiCTR1800017204；注册日期：2018年07月18日：关键词：房颤；老年人；多病症；预后

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.