Gottdiener John S, McClelland Robyn L, Marshall Robert, Shemanski Lynn, Furberg Curt D, Kitzman Dalane W, Cushman Mary, Polak Joseph, Gardin Julius M, Gersh Bernard J, Aurigemma Gerard P, Manolio Teri A
St. Francis Hospital, Roslyn, New York; Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Intern Med. 2002 Oct 15;137(8):631-9. doi: 10.7326/0003-4819-137-8-200210150-00006.
Most persons with congestive heart failure are elderly, and many elderly persons with congestive heart failure have normal left ventricular systolic function.
To evaluate the relationship between left ventricular systolic function and outcome of congestive heart failure in elderly persons.
Population-based longitudinal study of coronary heart disease and stroke.
Four U.S. sites: Forsyth County, North Carolina; Sacramento County, California; Allegheny County, Pennsylvania; and Washington County, Maryland.
5888 persons who were at least 65 years of age and were recruited from the community.
Total mortality and cardiovascular morbidity and mortality.
Of 5532 participants, 269 (4.9%) had congestive heart failure. Among these, left ventricular function was normal in 63%, borderline decreased in 15%, and overtly impaired in 22%. The mortality rate was 25 deaths per 1000 person-years in the reference group (no congestive heart failure and normal left ventricular function at baseline); 154 deaths per 1000 person-years in participants with congestive heart failure and impaired left ventricular systolic function; 87 and 115 deaths per 1000 person-years in participants with congestive heart failure and normal or borderline systolic function, respectively; and 89 deaths per 1000 person-years in persons with impaired left ventricular function but no congestive heart failure. Although the risk for death from congestive heart failure was lower in persons with normal systolic function than in those with impaired function, more deaths were associated with normal systolic function because more persons with heart failure fall into this category.
Community-dwelling elderly persons, especially those with impaired left ventricular function, have a substantial risk for death from congestive heart failure. However, more deaths occur from heart failure in persons with normal systolic function because left ventricular function is more often normal than impaired in elderly persons with heart failure.
大多数充血性心力衰竭患者为老年人，且许多老年充血性心力衰竭患者的左心室收缩功能正常。
评估老年人心力衰竭患者左心室收缩功能与预后之间的关系。
基于人群的冠心病和中风纵向研究。
美国四个地点：北卡罗来纳州福赛斯县；加利福尼亚州萨克拉门托县；宾夕法尼亚州阿勒格尼县；马里兰州华盛顿县。
5888名年龄至少65岁且从社区招募的人员。
全因死亡率以及心血管疾病的发病率和死亡率。
在5532名参与者中，269人（4.9%）患有充血性心力衰竭。其中，63%的患者左心室功能正常，15%的患者左心室功能临界降低，22%的患者左心室功能明显受损。在参照组（无充血性心力衰竭且基线时左心室功能正常）中，死亡率为每1000人年25例死亡；在充血性心力衰竭且左心室收缩功能受损的参与者中，死亡率为每1000人年154例死亡；在充血性心力衰竭且收缩功能正常或临界的参与者中，死亡率分别为每1000人年87例和115例死亡；在左心室功能受损但无充血性心力衰竭的参与者中，死亡率为每1000人年89例死亡。虽然收缩功能正常的患者因充血性心力衰竭死亡的风险低于收缩功能受损的患者，但与收缩功能正常相关的死亡人数更多，因为心力衰竭患者中收缩功能正常的人数多于收缩功能受损的人数。
居住在社区的老年人，尤其是左心室功能受损的老年人，有患充血性心力衰竭死亡的重大风险。然而，收缩功能正常的心力衰竭患者死亡人数更多，因为在老年心力衰竭患者中，左心室功能正常的情况比功能受损更为常见。
