ABSTRACT
OBJECTIVE: This study explored the effectiveness of a newly constructed frailty index (FI) for predicting short-term and long-term mortality in patients with chronic heart failure (HF). MATERIALS AND METHODS: This retrospective study included inpatients aged ≥60 years diagnosed with chronic HF at a teaching hospital in western China. General data on the patients were collected from the electronic medical record system between January 1, 2017, and July 7, 2022, and death information was obtained from follow-up calls made from July 31, 2022, to August 1, 2022. Receiver operating characteristic (ROC) curves were used to analyze the accuracy of the FI in predicting death in patients with chronic HF. Logistic regression (during hospitalization and within 30 days after discharge) and Cox regression (within 180 days after discharge and one year after discharge) analyses were used to assess associations between frailty and mortality risk in elderly patients with chronic HF. RESULTS: A total of 432 patients with chronic HF were included in the study. The non-frail group had FI values <0.3, while the FI values in the frail group were ≥0.3. Overall, 130 patients (30.09 %) were diagnosed with frailty, 66 (15.28 %) died during hospitalization or within 30 days after discharge, 55 (12.73 %) died within 180 days after discharge, and 68 (15.74 %) died within one year after discharge. The in-hospital and 30-day mortality rates, the 180-day mortality rates, and the 1-year mortality rates were higher in frail patients than in non-frail patients (in-hospital and 30-day mortality rates, 37.69 % vs. 5.63 %, P < 0.001; within 180 days, 30.61 % vs. 8.45 %, P < 0.001; within 1 year, 34.69 % vs. 11.49 %, P < 0.001). The area under the curve (AUC) values of FI for predicting in-hospital and 30-day mortality after discharge were 0.804, with values of 0.721 for 180-day mortality after discharge and 0.720 for 1-year mortality after discharge. Logistic regression analysis with adjustment for potential confounders indicated that frail HF patients had a higher risk of death during hospitalization and within 30 days than non-frail patients (odds ratio [OR] = 4.98, 95 % confidence interval [CI]: 2.46-10.09). Cox regression analysis with adjustment for potential confounders showed that frail HF patients had a higher risk of death within 180 days (hazard ratio [HR] = 2.63, 95 %CI: 1.47-4.72) and within 1 year (HR = 2.01, 95 %CI: 1.19-3.38). CONCLUSION: The results of this study showed that the new FI constructed according to the established construction rules could predict the in-hospital mortality and the risk of death within 30 days after discharge, 180 days after discharge, and 1 year after discharge in patients with chronic HF.
ABSTRACT
Objective: This study aimed to investigate the accuracy and consistency of different ultrasound protocols for the measurement of gastrocnemius muscle (GM) thickness and to identify a suitable ultrasound scheme that can be used to detect the low muscle mass in older with disability. Materials and methods: In this cross-sectional study, each participant underwent three different ultrasound protocols for the measurement of the GM thickness, and each measurement was repeated three times. The three measurement schemes were as follows: method A, lying on the examination bed in a prone position with legs stretched and relaxed and feet hanging outside the examination bed; method B, lateral right side lying position with legs separated (left leg flexed and right leg in a relaxed state); and method C, right side lying position with legs together and lower limb muscles in a relaxed state. The low muscle mass was determined by averaging two or three measurements of the GM thickness determined using different sonographic protocols. Results: The study included 489 participants. The difference in the prevalence of low muscle mass identified between two and three replicates of the same measurement protocol ranged from 0 to 1.3%. Considering the three repeated measurements of the method A as the reference, the area under the curve (AUC) in different measurement schemes were 0.977-1 and 0.973-1 in males and females, respectively. Furthermore, male and female Kappa values from low to high were 0.773, 0.801, 0.829, 0.839, and 0.967 and 0.786, 0.794, 0.804, 0.819, and 0.984, respectively. Conclusion: Different ultrasound measurement protocols showed high accuracy and consistency in identifying low muscle mass. Repeating the measurements two or three times was found to be feasible.