| 1 | Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study显示文摘Background Atrial fibrillation(AF) and heart failure(HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF(Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF(mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results Patients with prevalent HF(n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2 DS2 VASC and HAS-BLED scores than patients without HF(all P's < 0.01). In multivariable adjusted regression models, HF(present vs. absent) was associated with both prevalent frailty(adjusted odds ratio [a OR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year(a OR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment(a OR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year(a OR 1.04, 95%CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration. | Wei-Jia WANG Darleen Lessard Jane Saczynski Robert J Goldberg Alan S.Go Tenes Paul Ely Gracia David D McManus | 2020 | Journal of Geriatric Cardiology2020，17，11： | 2 |
| 2 | 他汀治疗与心力衰竭患者住院、死亡的危险显示文摘背景:他汀治疗对心力衰竭患者的临床结果是否有益仍不清楚。
目的:评估开始他汀治疗与慢性心力衰竭患者发生死亡或住院危险的关系。
设计、地点和患者:于确诊心力衰竭的患者中进行的趋势校正队列研究。患者适合降脂治疗,但从1996年1月1日至2004年12月31日,在北加利福尼亚一家综合性保健救助系统治疗前未予他汀治疗。他汀的使用于药房数据库通过填写的门诊处方确定。
主要观测指标:在中位数2.4年的随访期间,心力衰竭患者之全因死亡和住院。在多变量校正潜在混淆因素后,我们检查了他汀治疗与总不良事件以及与有或无冠心病亚组不良事件的独立关系。
结果:在24598例以前未使用他汀的心力衰竭成年患者中,开始他汀治疗(n=12648;51.4%)的患者较为年轻,更可能为男性,更可能患心血管病、糖尿病和高血压。有8235例患者死亡。使用意向治疗方法,他汀的使用与心力衰竭患者发生死亡(使用他汀治疗组与未使用他汀治疗组年龄、性别校正后死亡率为14.5/100病人-年比25.3/100病人-年;校正后风险比,0.76[95%可信区间,0.72~0.80])和住院(年龄、性别校正后发生率为21.9/100病人-年比31.1/100病人-年;校正风险比,0.79[95%可信区间,0.74~0.85])的危险较低相关,即使在校正他汀使用趋势、胆固醇水平、其他心血管药物或潜在混淆因素后结果亦如此。他汀的使用与有或无已知冠心病患者发生不良结局之校正后风险较低相关。
结论:在已确诊心力衰竭且以前未用他汀的患者中,他汀的使用与有或无冠心病患者发生死亡或住院危险较低相关。 | Alan S.Go Wendy Y.Lee Jingrong Yang 李呈亿(译) | 2007 | 美国医学会杂志(中文版)2007，26，5： | 1 |
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