Havranek Edward P, Masoudi Frederick A, Westfall Kelly A, Wolfe Pam, Ordin Diana L, Krumholz Harlan M
Colorado Foundation for Medical Care, Aurora, Colo, USA.
Am Heart J. 2002 Mar;143(3):412-7. doi: 10.1067/mhj.2002.120773.
The elderly make up the majority of patients with heart failure (HF), but information on this segment of the HF population is lacking because clinical trials typically enroll younger patients and population-based studies lack clinical detail. We sought to describe a contemporary national sample of elderly patients with HF and to examine the sample for age-related trends in clinical characteristics.
We studied the charts of 800 Medicare patients per state who were hospitalized with a principal diagnosis of HF between April 1998 and March 1999. There were 34,587 patients in the sample after exclusion of patients who were <65 years old, repeat discharges, discharges to another acute care facility or against medical advice, or receiving long-term hemodialysis.
Comorbidity was common. About one third of patients had chronic obstructive pulmonary disease, about 40% had diabetes, more than half had coronary heart disease, and more than half had a history of hypertension, but comorbidity rates declined with age. Left ventricular ejection fraction was <40% in only 50.4% of patients in whom it was assessed. Associated laboratory abnormalities were relatively constant across the age spectrum, but renal insufficiency was more common with advancing age. The likelihood that patients were in long-term care facilities before admission rose quite steeply with age.
Elderly patients with HF are a heterogeneous group and appear to differ substantially from patients enrolled in clinical trials. Evidence-based guidance for treatment in the context of multiple comorbid conditions, poor renal function, HF with preserved left ventricular systolic function, and residence in long-term care facilities is urgently needed.
老年人构成了心力衰竭（HF）患者的大多数，但由于临床试验通常纳入较年轻的患者，且基于人群的研究缺乏临床细节，因此关于这部分HF人群的信息匮乏。我们试图描述当代全国老年HF患者样本，并检查该样本临床特征的年龄相关趋势。
我们研究了1998年4月至1999年3月期间因HF为主诊断而住院的每个州800名医疗保险患者的病历。排除年龄<65岁、再次出院、转至另一家急性护理机构或违反医嘱出院或接受长期血液透析的患者后，样本中有34,587名患者。
合并症很常见。约三分之一的患者患有慢性阻塞性肺疾病，约40%患有糖尿病，超过一半患有冠心病，超过一半有高血压病史，但合并症发生率随年龄下降。仅50.4%接受评估的患者左心室射血分数<40%。相关实验室异常在各年龄组中相对恒定，但肾功能不全随年龄增长更为常见。患者入院前入住长期护理机构的可能性随年龄急剧上升。
老年HF患者是一个异质性群体，似乎与临床试验中纳入的患者有很大不同。迫切需要针对多种合并症、肾功能差、左心室收缩功能保留的HF以及长期护理机构居住情况的循证治疗指南。
