Croft J B, Giles W H, Pollard R A, Keenan N L, Casper M L, Anda R F
Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
Arch Intern Med. 1999 Mar 8;159(5):505-10. doi: 10.1001/archinte.159.5.505.
To describe the 6-year probability of survival for older adults after their first hospitalization for heart failure.
National Medicare hospital claims records for 1984 through 1986 and Medicare enrollment records from 1986 through 1992.
We identified a national cohort of 170 239 (9% black patients) Medicare patients, 67 years or older, with no evidence of heart failure in 1984 or 1985, who were hospitalized and discharged for the first time in 1986 with a principal diagnosis of heart failure. For groups defined by race, sex, age, Medicaid eligibility, and comorbid conditions, we compared the probability of survival with Cox proportional hazards regression.
Only 19% of black men, 16% of white men, 25% of black women, and 23% of white women survived 6 years. One third died within the first year. Men had lower median survival and 38% greater risk of mortality than did women (P<.05). White men had 10% greater risk of mortality than did black men (P<.05). Medicaid eligibility (white adults only) and diabetes were associated with increased mortality (P<.05).
The prognosis for older adults with heart failure underscores the importance of prevention strategies and early detection and treatment modalities that can prevent, improve, or reverse myocardial dysfunction, particularly for the growing number of adults who are at increased risk for developing heart failure because of hypertension, diabetes, or myocardial infarction.
描述老年人心力衰竭首次住院后的6年生存率。
1984年至1986年的国家医疗保险医院理赔记录以及1986年至1992年的医疗保险参保记录。
我们确定了一个全国性队列，由170239名（9%为黑人患者）医疗保险患者组成，年龄在67岁及以上，在1984年或1985年无心力衰竭证据，于1986年首次因心力衰竭住院并出院。对于按种族、性别、年龄、医疗补助资格和合并症定义的组，我们使用Cox比例风险回归比较生存率。
只有19%的黑人男性、16%的白人男性、25%的黑人女性和23%的白人女性存活了6年。三分之一的人在第一年内死亡。男性的中位生存期较短，死亡风险比女性高38%（P<0.05）。白人男性的死亡风险比黑人男性高10%（P<0.05）。医疗补助资格（仅针对白人成年人）和糖尿病与死亡率增加相关（P<0.05）。
老年人心力衰竭的预后凸显了预防策略以及能够预防、改善或逆转心肌功能障碍的早期检测和治疗方式的重要性，特别是对于因高血压、糖尿病或心肌梗死而患心力衰竭风险增加的成年人数量不断增加的情况。
