Jong Philip, Vowinckel Erika, Liu Peter P, Gong Yanyan, Tu Jack V
Heart & Stroke/Richard Lewar Centre of Excellence and the Toronto General Hospital, University Health Network, Ontario, Canada.
Arch Intern Med. 2002;162(15):1689-94. doi: 10.1001/archinte.162.15.1689.
The prognosis in unselected community-dwelling patients with heart failure has not been widely studied.
To determine the short- and long-term mortality of patients after first hospitalizations for heart failure and to examine how age, sex, and comorbidities influence survival.
We used the Canadian Institute for Health Information database to construct a retrospective population-based cohort of 38 702 consecutive patients with first-time admissions for heart failure from April 1994 through March 1997 in Ontario, Canada. Prognostic variables were collected from hospital discharge abstracts. Vital status at 30 days and 1 year was determined through linkage with the Ontario Registered Persons Database. Regression analyses were used to identify the relationships among survival, age, sex, and comorbidities.
The crude 30-day and 1-year case-fatality rates after first admissions for heart failure were 11.6% and 33.1%, respectively. Advancing age, male sex, and the presence of comorbidities as identified by the Charlson Index were independently associated with poorer survival. The 30-day and 1-year mortality ranged from 2.3% and 7.6%, respectively, in the youngest subgroup with minimal comorbidity to 23.8% and 60.7%, respectively, in the oldest comorbidity-laden subgroup. Complex interactions among age and sex, sex and comorbidities, and age and comorbidities were observed in models of short- and long-term survival.
The prognosis of unselected community-dwelling patients with heart failure remains poor, despite advances in treatment, with substantial variation seen across different subgroups. Although age, sex, and comorbidities were confirmed to be independent prognostic indicators of heart failure, their complex interaction with survival should be considered in future studies.
未经过挑选的社区心力衰竭患者的预后情况尚未得到广泛研究。
确定心力衰竭首次住院患者的短期和长期死亡率，并研究年龄、性别和合并症如何影响生存情况。
我们使用加拿大卫生信息研究所的数据库，构建了一个基于人群的回顾性队列，该队列包含1994年4月至1997年3月在加拿大安大略省连续首次因心力衰竭入院的38702例患者。预后变量从医院出院摘要中收集。通过与安大略省注册人员数据库链接确定30天和1年时的生命状态。采用回归分析来确定生存、年龄、性别和合并症之间的关系。
心力衰竭首次入院后的30天和1年粗病死率分别为11.6%和33.1%。年龄增长、男性以及Charlson指数确定的合并症的存在与较差的生存独立相关。在合并症最少的最年轻亚组中，30天和1年死亡率分别为2.3%和7.6%，而在合并症最多的最年长亚组中分别为23.8%和60.7%。在短期和长期生存模型中观察到年龄与性别、性别与合并症以及年龄与合并症之间存在复杂的相互作用。
尽管治疗取得了进展，但未经过挑选的社区心力衰竭患者的预后仍然很差，不同亚组之间存在很大差异。虽然年龄、性别和合并症被证实是心力衰竭的独立预后指标，但在未来研究中应考虑它们与生存的复杂相互作用。
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