老年急性心力衰竭合并心房颤动患者出院自理恢复影响因素及交互作用

Factors influencing self-care recovery in older patients with acute heart failure and atrial fibrillation after discharge and the interactions among these factors

中文关键词: 老年人    急性心力衰竭    心房颤动    自理能力    影响因素    交互作用

英文关键词: older adultsacute heart failureatrial fibrillationself-care abilityinfluencing factorinteraction

中文摘要:

      目的 探讨老年急性心力衰竭(AHF)合并心房颤动(AF)患者出院后早期自理能力恢复的影响因素，并分析各因素间的交互作用。方法 选取2022年6月至2025年5月于张家口市第一医院心血管内科住院治疗的老年AHF合并AF患者226例为研究对象，开展前瞻性随访研究。收集患者人口学特征、临床指标、治疗相关因素及心理社会因素等临床资料，以出院后3个月巴塞尔指数(BI)作为自理能力恢复的评价指标，将BI≥60分定义为自理能力恢复良好，BI <60分定义为自理能力恢复不佳。采用单因素分析初步筛选变量，通过多因素二元Logistic回归分析确定独立影响因素，并引入交互项，分析各影响因素间的交互作用。结果 226例患者出院后3个月BI评分为(62.58±18.34)分，较出院时的(45.36±12.89)分显著升高(t=11.548,P <0.001);其中自理能力恢复良好138例(61.06%)，恢复不佳88例(38.94%)。多因素二元Logistic回归分析结果显示，年龄≥75岁[比值比(OR)=2.687,95%置信区间(CI):1.531～4.694]、纽约心脏病协会(NYHA)心功能Ⅳ级(OR=3.473,95%CI:1.883～6.432)、B型利钠肽(BNP)≥1 000 pg/mL(OR=2.372,95%CI:1.312～4.317)、抑郁状态(OR=2.789,95%CI:1.568～4.963)是老年患者出院后自理能力恢复不佳的独立危险因素(均P <0.001);规范服用抗凝药物(OR=0.410,95%CI:0.225～0.750)、坚持规律心脏康复训练(OR=0.357,95%CI:0.192～0.643)、高社会支持(OR=0.323,95%CI:0.171～0.608)是自理能力恢复的独立保护因素(均P <0.001)。交互作用分析显示，以年龄≥75岁且未坚持规律心脏康复训练为参照，年龄<75岁与坚持规律心脏康复训练存在正向协同保护效应[OR=0.332,95%CI:0.167～0.693，相对超额风险(RERI)=0.613，交互作用归因比(AP)=0.484，协同指数(S)=2.134];以无抑郁状态且高社会支持为参照，抑郁状态与低社会支持存在正向协同危险效应(OR=3.643,95%CI:1.861～7.277,RERI=1.143,AP=0.312,S=1.585)。结论 老年AHF合并AF患者出院后早期自理能力恢复受年龄、NYHA心功能分级、BNP水平及抑郁状态的综合影响;规范抗凝治疗、规律心脏康复训练及高社会支持与自理能力恢复相关，临床可基于上述结果制定个体化康复干预方案，以改善患者预后。

英文摘要:

      Objective To investigate the factors influencing early recovery of self-care ability in older patients with acute heart failure(AHF)complicated with atrial fibrillation(AF)after discharge,and to analyze the interaction effects among these factors.Methods A prospective follow-up study was conducted.A total of 226 older patients with AHF and AF who were hospitalized in the Department of Cardiovascular Medicine at First Hospital of Zhangjiakou City from June 2022 to May 2025 were enrolled.Clinical data including demographic characteristics,clinical indicators,treatment-related factors,and psychosocial factors were collected.The Barthel index(BI)at 3 months post-discharge was used as the evaluation indicator for recovery of self-care ability.A BI score≥60 was defined as good recovery,and BI＜60 was defined as poor recovery.Univariate analysis was used to preliminarily screen variables,and multivariate binary Logistic regression analysis was used to identify independent influencing factors.Interaction terms were introduced to analyze the interaction effects among these factors.Results The BI score of the 226 patients at 3 months post-discharge was(62.58±18.34),which was significantly higher than that at discharge[(45.36±12.89),t=11.548,P＜0.001].Among them,138 patients(61.06%)achieved good self-care recovery,while 88(38.94%)had poor recovery.Multivariate binary Logistic regression analysis showed that age≥75 years[odds ratio(OR)=2.687,95%confidence interval(CI):1.531-4.694],New York Heart Association(NYHA)cardiac function grade Ⅳ(OR=3.473,95%CI:1.883-6.432),B-type natriuretic peptide(BNP)≥1 000 pg/mL(OR=2.372,95%CI:1.312-4.317),and depressive state(OR=2.789,95%CI:1.568-4.963)were independent risk factors for poor recovery of self-care ability in older patients after discharge(all P＜0.001);standardized use of anticoagulant drugs(OR=0.410,95%CI:0.225-0.750),adherence to regular cardiac rehabilitation training(OR=0.357,95%CI:0.192-0.643),and high social support(OR=0.323,95%CI:0.171-0.608)were independent protective factors for recovery of self-care ability(all P＜0.001).Interaction analysis showed that,with age≥75 years and non-adherence to regular cardiac rehabilitation training as the reference,age＜75 years and adherence to regular cardiac rehabilitation training had a positive synergistic protective effect(OR=0.332,95%CI:0.167-0.693,relative excess risk due to interaction(RERI)=0.613,attributable proportion due to interaction(AP)=0.484,synergy index(S)=2.134);with non-depressive state and high social support as the reference,depressive state and low social support had a positive synergistic risk effect(OR=3.643,95%CI:1.861-7.277,RERI=1.143,AP=0.312,S=1.585).Conclusion Early recovery of self-care ability in older patients with AHF and AF after discharge is comprehensively influenced by age,NYHA cardiac functional grade,BNP level,and depressive state.Standardized anticoagulation therapy,regular cardiac rehabilitation training,and high social support are associated with better recovery of self-care ability.Clinically,individualized rehabilitation intervention programs should be developed based on these findings to improve patients prognosis.