一项关于纽约心脏协会心功能分级与心力衰竭自然史终点的倾向匹配研究。
A propensity matched study of New York Heart Association class and natural history end points in heart failure.
作者信息
Ahmed Ali
机构信息
University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
Am J Cardiol. 2007 Feb 15;99(4):549-53. doi: 10.1016/j.amjcard.2006.08.065. Epub 2006 Dec 28.
The association between higher New York Heart Association (NYHA) functional class and poor outcome in heart failure (HF) is well known. However, to what extent these associations are confounded by covariates such as age, the severity of disease, and co-morbidity burden is unknown. In the Digitalis Investigation Group (DIG) trial, 2,441 of the 7,788 patients with chronic HF had NYHA class III or IV symptoms. Propensity scores for NYHA classes III and IV were calculated for each patient and were then used to match 1,863 patients in NYHA classes III and IV with 1,863 patients in NYHA classes I and II. Kaplan-Meier and matched Cox regression analyses were used to estimate associations of NYHA class III or IV with mortality and hospitalizations during a median of 37 months of follow-up. Compared with 34% (641 of 1,863) patients in NYHA classes I and II (mortality rate 1,175 in 10,000 person-years of follow-up), 42% (777 of 1,863) patients in NYHA classes III and IV (mortality rate 1,505 in 10,000 person-years) died from all causes (hazard ratio 1.29, 95% confidence interval [CI] 1.14 to 1.45, p <0.0001). Hospitalizations due to all causes occurred in 66% (1,232 of 1,863) patients in NYHA classes I and II (hospitalization rate 3,898 in 10,000 person-years) and 71% (1,322 of 1,863) patients in NYHA classes III and IV (hospitalization rate 4,793 in 10,000 person-years) (hazard ratio 1.16, 95% CI 1.05 to 1.28, p = 0.003). The hazard ratios for patients in NYHA classes III and IV, compared with those for those in NYHA classes I and II, for other outcomes were 1.29 for cardiovascular mortality (95% CI 1.12 to 1.48, p <0.0001), 1.49 for HF mortality (95% CI 1.20 to 1.84, p <0.0001), 1.18 for cardiovascular hospitalization (95% CI 1.06 to 1.32, p = 0.002), and 1.17 for HF hospitalization (95% CI 1.03 to 1.34, p = 0.017). In conclusion, baseline NYHA class is a marker of hospitalization, disease progression, and mortality in a wide spectrum of ambulatory patients with chronic HF.
纽约心脏协会（NYHA）心功能分级较高与心力衰竭（HF）患者预后不良之间的关联已广为人知。然而，这些关联在多大程度上受到年龄、疾病严重程度和合并症负担等协变量的混杂影响尚不清楚。在洋地黄研究组（DIG）试验中，7788例慢性HF患者中有2441例有NYHA III或IV级症状。为每位患者计算NYHA III级和IV级的倾向得分，然后用于将1863例NYHA III级和IV级患者与1863例NYHA I级和II级患者进行匹配。采用Kaplan-Meier和匹配Cox回归分析来估计NYHA III级或IV级与中位随访37个月期间死亡率和住院率之间的关联。与NYHA I级和II级的34%（1863例中的641例）患者（10000人年随访中的死亡率为1175）相比，NYHA III级和IV级的42%（1863例中的777例）患者（10000人年中的死亡率为1505）死于各种原因（风险比1.29，95%置信区间[CI]1.14至1.45，p<0.0001）。NYHA I级和II级的66%（1863例中的1232例）患者（10000人年住院率为3898）和NYHA III级和IV级的71%（1863例中的1322例）患者（10000人年住院率为4793）因各种原因住院（风险比1.16，95%CI 1.05至1.28，p = 0.003）。与NYHA I级和II级患者相比，NYHA III级和IV级患者在其他结局方面的风险比分别为：心血管死亡率1.29（95%CI 1.12至1.48，p<0.0001），HF死亡率1.49（95%CI 1.20至1.84，p<0.0001），心血管住院率1.18（95%CI 1.06至1.32，p = 0.002），HF住院率1.17（95%CI 1.03至1.34，p = 0.017）。总之，基线NYHA分级是广泛的门诊慢性HF患者住院、疾病进展和死亡的一个标志物。
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