Goldberg Robert J, Ciampa Julia, Lessard Darleen, Meyer Theo E, Spencer Frederick A
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Arch Intern Med. 2007 Mar 12;167(5):490-6. doi: 10.1001/archinte.167.5.490.
Heart failure (HF) is a major public health problem that is associated with substantial morbidity, impaired quality of life, and diminished survival. Despite the considerable prevalence of HF in the United States, there are limited published data describing the contemporary long-term prognosis of patients hospitalized with decompensated HF.
A total of 2445 residents in the Worcester metropolitan area discharged from 11 greater Worcester hospitals after confirmed acute HF during 2000 comprised the study sample. Follow-up of discharged hospital survivors was carried out through 2005.
The mean age of the study population was 76 years, 43.4% were men, and approximately three quarters had been previously diagnosed as having HF. Among discharged hospital patients, 37.3% died during the first year after hospital discharge, while 78.5% died during the 5-year follow-up period. Several subgroups of patients were at significantly increased risk for dying during the first year after hospital discharge. This included older persons (> or =85 years) (adjusted odds ratio [OR], 2.11; 95% confidence interval [CI], 1.35-3.29), patients with a history of chronic obstructive pulmonary disease (OR, 1.39; 95% CI, 1.15-1.69) or HF (OR, 1.26; 95% CI, 1.00-1.59), and patients with elevated serum urea nitrogen levels during hospitalization (OR, 1.02; 95% CI, 1.01-1.03).
The results of our community-wide study demonstrate the poor long-term prognosis of patients surviving hospitalization for decompensated HF. Despite advances in the therapeutic management of these patients, their long-term survival remains guarded. Efforts are needed to improve the long-term survival of patients with this clinical syndrome.
心力衰竭（HF）是一个重大的公共卫生问题，与严重的发病率、生活质量受损及生存率降低相关。尽管在美国HF的患病率相当高，但关于失代偿性HF住院患者当代长期预后的已发表数据有限。
2000年期间，从伍斯特市11家大医院确诊急性HF后出院的伍斯特大都市区的2445名居民构成了研究样本。对出院后的医院幸存者进行随访直至2005年。
研究人群的平均年龄为76岁，43.4%为男性，约四分之三的人先前被诊断患有HF。在出院患者中，37.3%在出院后第一年死亡，而78.5%在5年随访期内死亡。几个患者亚组在出院后第一年死亡风险显著增加。这包括老年人（≥85岁）（调整后的优势比[OR]，2.11；95%置信区间[CI]，1.35 - 3.29）、有慢性阻塞性肺疾病史的患者（OR，1.39；95% CI，1.15 - 1.69）或HF患者（OR，1.26；95% CI，1.00 - 1.59），以及住院期间血清尿素氮水平升高的患者（OR，1.02；95% CI，1.01 - 1.03）。
我们的社区范围研究结果表明，失代偿性HF住院存活患者的长期预后较差。尽管这些患者的治疗管理取得了进展，但其长期生存仍不容乐观。需要努力改善患有这种临床综合征患者的长期生存。
