VillaCorta Humberto, Mesquita Evandro Tinoco, Cardoso Rosana, Bonates Therezil, Maia Eduardo Reis, Silva Antônio Cláudio M, Guimarães Marici A P, Dohmann Hans J F
Hospital Pró-Cardíaco-Emergency Department-Rio de Janeiro, Brasil.
Rev Port Cardiol. 2003 Apr;22(4):495-507.
Several predictors of survival have been described in stable heart failure (HF) patients. Few reports have focused on decompensated patients.
We studied 170 patients who presented to the emergency department (ED) with decompensated HF. Mean age was 72.5 +/- 13 years (range 17 to 99) and 107 (63%) were male. We evaluated clinical features, in-hospital evolution, and prognostic factors related to all-cause mortality in a mean follow-up of 14 +/- 8.6 months (range 1 to 36).
Eighteen (10.6%) patients died during the index admission. During outpatient follow-up, 45 deaths occurred. One-year survival rate for the population as a whole was 63%. Advanced age (hazard ratio [HR] = 1.27 per 10-year increment; 95% confidence interval [CI], 1.04 to 1.55; p = 0.017), mean arterial pressure (inverse relationship with total mortality, HR = 0.83 per 10 mmHg increment; 95% CI, 0.72 to 0.95; p = 0.008) and hyponatremia (HR = 2.0; 95% CI, 1.19 to 3.36; p = 0.009) were found to be independent predictors of survival.
Patients who present to the ED with decompensated HF have high mortality rates. Those at increased risk can be identified early in the ED.
已有多项研究描述了稳定型心力衰竭（HF）患者的生存预测因素。但针对失代偿患者的报道较少。
我们研究了170例因失代偿性HF就诊于急诊科（ED）的患者。平均年龄为72.5±13岁（范围17至99岁），其中107例（63%）为男性。我们评估了临床特征、住院期间的病情演变以及在平均随访14±8.6个月（范围1至36个月）期间与全因死亡率相关的预后因素。
18例（10.6%）患者在首次住院期间死亡。在门诊随访期间，又有45例死亡。总体人群的1年生存率为63%。高龄（风险比[HR]=每增加10岁为1.27；95%置信区间[CI]，1.04至1.55；p=0.017）、平均动脉压（与总死亡率呈负相关，HR=每增加10 mmHg为0.83；95% CI，0.72至0.95；p=0.008）和低钠血症（HR=2.0；95% CI，1.19至3.36；p=0.009）被发现是生存的独立预测因素。
因失代偿性HF就诊于ED的患者死亡率很高。在ED早期就能识别出那些风险增加的患者。
