Owan Theophilus E, Hodge David O, Herges Regina M, Jacobsen Steven J, Roger Veronique L, Redfield Margaret M
Cardiorenal Research Laboratory, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
N Engl J Med. 2006 Jul 20;355(3):251-9. doi: 10.1056/NEJMoa052256.
BACKGROUND: The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved ejection fraction among patients at a single institution over a 15-year period. METHODS: We studied all consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, from 1987 through 2001. We classified patients as having either preserved or reduced ejection fraction. The patients were also classified as community patients (Olmsted County residents) or referral patients. Secular trends in the type of heart failure, associated cardiovascular disease, and survival were defined. RESULTS: A total of 6076 patients with heart failure were discharged over the 15-year period; data on ejection fraction were available for 4596 of these patients (76 percent). Of these, 53 percent had a reduced ejection fraction and 47 percent had a preserved ejection fraction. The proportion of patients with the diagnosis of heart failure with preserved ejection fraction increased over time and was significantly higher among community patients than among referral patients (55 percent vs. 45 percent). The prevalence rates of hypertension, atrial fibrillation, and diabetes among patients with heart failure increased significantly over time. Survival was slightly better among patients with preserved ejection fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival improved over time for those with reduced ejection fraction but not for those with preserved ejection fraction. CONCLUSIONS: The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.
背景：由于人口统计学变化以及心力衰竭危险因素的患病率和治疗情况的改变，射血分数保留的心力衰竭患病率可能正在发生变化。射血分数保留的心力衰竭患病率的变化可能会导致心力衰竭自然史的改变。我们开展了一项研究，以确定在15年期间一家单一机构中射血分数保留的心力衰竭患者的患病率的长期趋势。 方法：我们研究了1987年至2001年在明尼苏达州奥尔姆斯特德县梅奥诊所医院因失代偿性心力衰竭住院的所有连续患者。我们将患者分为射血分数保留或降低两类。患者还被分为社区患者（奥尔姆斯特德县居民）或转诊患者。确定了心力衰竭类型、相关心血管疾病和生存率的长期趋势。 结果：在这15年期间，共有6076例心力衰竭患者出院；其中4596例患者（76%）有射血分数数据。其中，53%的患者射血分数降低，47%的患者射血分数保留。射血分数保留的心力衰竭诊断患者比例随时间增加，且社区患者中的比例显著高于转诊患者（55%对45%）。心力衰竭患者中高血压、心房颤动和糖尿病的患病率随时间显著增加。射血分数保留的患者生存率略高（死亡调整风险比为0.96；P = 0.01）。射血分数降低的患者生存率随时间改善，但射血分数保留的患者则不然。 结论：在15年期间，射血分数保留的心力衰竭患病率增加，而该疾病的死亡率保持不变。这些趋势凸显了这个日益严重的公共卫生问题的重要性。
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