Muntwyler J, Abetel G, Gruner C, Follath F
Department of Internal Medicine, Room C-Hor 47, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland.
Eur Heart J. 2002 Dec;23(23):1861-6. doi: 10.1053/euhj.2002.3282.
To estimate 1-year mortality and prognostic factors in unselected outpatients with heart failure, and to compare the observed mortality with the estimates of the primary care physicians.
Four hundred and eleven consecutive patients with heart failure New York Heart Association (NYHA) class II-IV (mean population age 75 years, 56% males) were enrolled in 71 primary care offices throughout Switzerland. During a mean follow-up period of 1.4 years, 68 patients had died. One-year total mortality was 12.6% compared to 4.3% in the underlying Swiss population (standardized mortality ratio 3.0). Among patients with heart failure NYHA II, III and IV, mortality was 7.1%, 15.0% and 28.0%, respectively. In multivariate Cox regression, statistically significant (P<0.05) predictors of mortality were NYHA class (NYHA III: risk ratio [RR]=1.6; NYHA IV: RR=2.2), recent hospital stay for heart disease (RR=2.3), creatinine>120 micromol.l(-1) (RR=1.8) systolic blood pressure<100 mmHg (RR=2.4), heart rate>100 min(-1) (RR=2.7), age (per 10 years, RR=1.6) and female gender (RR=0.49). Among patients with reduced left ventricular ejection fraction, 1-year mortality was 14.3%, and predictors were similar except that female gender was no longer associated with reduced mortality. Primary care physicians significantly overestimated 1-year mortality (estimated mortality 25.9% vs observed mortality 12.6%,P =0.001).
Unselected outpatients with heart failure have a poor prognosis, particularly those with advanced heart failure and a recent hospital stay for heart disease. Primary care physicians are aware of the high mortality of this growing patient population.
评估未经挑选的门诊心力衰竭患者的1年死亡率及预后因素，并将观察到的死亡率与基层医疗医生的估计值进行比较。
瑞士各地71家基层医疗诊所纳入了411例连续的纽约心脏病协会（NYHA）II-IV级心力衰竭患者（平均人群年龄75岁，男性占56%）。在平均1.4年的随访期内，68例患者死亡。1年总死亡率为12.6%，而瑞士基础人群的死亡率为4.3%（标准化死亡率3.0）。NYHA II、III和IV级心力衰竭患者的死亡率分别为7.1%、15.0%和28.0%。在多因素Cox回归分析中，死亡率的统计学显著（P<0.05）预测因素为NYHA分级（NYHA III级：风险比[RR]=1.6；NYHA IV级：RR=2.2）、近期因心脏病住院（RR=2.3）、肌酐>120 μmol·l⁻¹（RR=1.8）、收缩压<100 mmHg（RR=2.4）、心率>100次/分钟（RR=2.7）、年龄（每增加10岁，RR=1.6）和女性（RR=0.49）。在左心室射血分数降低的患者中，1年死亡率为14.3%，预测因素相似，只是女性与死亡率降低不再相关。基层医疗医生显著高估了1年死亡率（估计死亡率25.9% vs 观察到的死亡率12.6%，P=0.001）。
未经挑选的门诊心力衰竭患者预后较差，尤其是那些晚期心力衰竭患者和近期因心脏病住院的患者。基层医疗医生意识到这一不断增加的患者群体死亡率较高。
