Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada

Febrero 2017

art ículo de investigaci ón 164 Rev Med Chile 2017; 145: 164-171 Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada Felipe Díaz-Toro1,a, Carolina Nazzal Nazal2,a,b, Hugo Verdejo3, VÍctor Rossel4, Pablo Castro3, Ricardo Larrea5, Roberto Concepción6, Luis Sepúlveda7 en representación del grupo ICARO Frailty in patients admitted to hospital with acute decompensated heart failure Background: Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. Aim: To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. Material and Methods: Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty (p < 0.05) were included in a multiple logistic regression model. Results: Seventy-nine subjects were included. The prevalence of frailty was 50.6%. Frail patients were mostly female (52.6%) and older than non-frail subjects (73.7± 7.9 vs 68.2 ± 7.1; p < 0.003). Independent predictors of frailty were age (Odds raio (OR) 1.10; 95% confidence intervals (CI): 1.03- 1.17), quality of life measured with the Minnesota Living with Heart Failure Questionnaire (OR 1.07; IC95%: 1.03-1.11), previous hospitalizations (OR 2.56; 95%CI: 1.02-6.43) and number of medications (OR 4.46; 95%CI: 1.11-17.32). Conclusions: The prevalence of frailty in patients admitted to the hospital for decompensated heart failure is high. Age, quality of life, hospitalizations and polypharmacy were factors associated with frailty in this group of participants. (Rev Med Chile 2017; 145: 164-171) Key words: Geriatrics; Frail Elderly; Heart Failure. 1Facultad de Enfermería, Escuela de Enfermería, Universidad Andrés Bello. Santiago, Chile. 2Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile. Santiago, Chile. 3Facultad de Medicina, Pontificia Universidad Católica de Chile. 4Departamento de Medicina Oriente. Facultad de Medicina. Universidad de Chile. Servicio de Medicina. Hospital del Salvador. Santiago, Chile. 5Unidad Coronaria. Clínica Dávila. Santiago, Chile. 6Servicio de Cardiología. Hospital DIPRECA. Santiago, Chile. 7Unidad Coronaria. Hospital Clínico Universidad de Chile. Santiago, Chile. aEnfermero. MPH. bEnfermera Matrona. Magíster en Salud Pública. Doctora en Salud Pública. Apoyo Financiero: Grant Novartis. Recibido el 26 de julio de 2016, aceptado el 10 de enero de 2017. Correspondencia a: Carolina Nazzal Nazal MPH, PhD. Escuela de Salud Pública. Facultad de Medicina. Universidad de Chile. Teléfono: +56-2-9786142 Avenida Independencia 939, Independencia. Santiago Chile. cnazzal@med.uchile.cl Fragilidad es un síndrome geriátrico que se emplea para definir a los adultos mayores que presentan una resistencia disminuida a factores estresantes (enfermedades, cirugías, entre otras) debido a una reserva fisiológica que también se encuentra reducida. En su definición más conceptual, se describe como un fenómeno patológico multisistémico, caracterizado por un equilibrio precario entre componentes biomecánicos y psicosociales, que representan un alto riesgo de institucionalización o muerte1,2. Estudios internacionales muestran prevalen


Febrero 2017
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