Lee Douglas S, Austin Peter C, Stukel Thérèse A, Alter David A, Chong Alice, Parker John D, Tu Jack V
Institute for Clinical Evaluative Sciences, Ont, Canada.
Am J Med. 2009 Feb;122(2):162-169.e1. doi: 10.1016/j.amjmed.2008.08.026. Epub 2008 Dec 26.
The mortality impact of recurrent cardiac hospitalizations has not been delineated in community-based heart failure patients. We determined if a "dose-dependent" relationship exists between heart failure events and death, accounting for temporal changes in age, comorbidities, and disease severity.
Among heart failure patients in the Enhanced Feedback For Effective Cardiac Treatment Study with onset between April 1999 and March 2001, we compared long-term survival (until March 2006) in those with recurrent heart failure or cardiovascular events, relative to those free of such events.
In 9138 patients, 28,442 person-years of follow-up were examined (mean age: 75.3 years, 49.6% male). Recurrent heart failure events occurred 1, 2, 3, and >or=4 times in 2352 (25.7%), 1020 (11.2%), 505 (5.5%), and 596 (6.5%) patients, respectively. Cardiovascular readmissions occurred 1, 2, 3, and >or=4 times in 2522 (27.6%), 1509 (16.5%), 975 (10.7%), and 1672 (18.3%) patients, respectively. Compared with those without recurrent heart failure events, the adjusted relative mortality rates for 1, 2, 3, and >or=4 heart failure events were 2.41 (95% confidence interval [CI], 2.24-2.60), 3.00 (95% CI 2.72-3.32), 4.00 (95% CI, 3.51-4.56), and 5.16 (95% CI, 4.55-5.85), respectively. Compared with those without cardiovascular events, the adjusted relative mortality rates for 1, 2, 3, and >or=4 cardiovascular events were 3.33 (95% CI, 3.05-3.63), 4.61 (95% CI, 4.16-5.10), 6.29 (95% CI, 5.59-7.07), and 8.95 (95% CI, 8.05-9.95), respectively.
The risk of death increases progressively and independently with each heart failure or cardiovascular event. The number of prior events predicts mortality and should be ascertained in patients with heart failure.
社区心力衰竭患者反复住院对死亡率的影响尚未明确。我们确定了心力衰竭事件与死亡之间是否存在“剂量依赖”关系，并考虑了年龄、合并症和疾病严重程度随时间的变化。
在1999年4月至2001年3月发病的强化心脏有效治疗反馈研究中的心力衰竭患者中，我们比较了发生反复心力衰竭或心血管事件的患者与未发生此类事件的患者的长期生存率（至2006年3月）。
9138例患者接受了28442人年的随访（平均年龄：75.3岁，男性占49.6%）。反复发生心力衰竭事件的患者分别为1次、2次、3次和≥4次的有2352例（25.7%）、1020例（11.2%）、505例（5.5%）和596例（6.5%）。心血管再入院患者分别为1次、2次、3次和≥4次的有2522例（27.6%）、1509例（16.5%）、975例（10.7%）和1672例（18.3%）。与未发生反复心力衰竭事件的患者相比，1次、2次、3次和≥4次心力衰竭事件的校正相对死亡率分别为2.41（95%置信区间[CI]，2.24 - 2.60）、3.00（95%CI 2.72 - 3.32）、4.00（95%CI，3.51 - 4.56）和5.16（95%CI，4.55 - 5.85）。与未发生心血管事件的患者相比，1次、2次、3次和≥4次心血管事件的校正相对死亡率分别为3.33（95%CI，3.05 - 3.63）、4.61（95%CI，4.16 - 5.10）、6.29（95%CI，5.59 - 7.07）和8.95（95%CI，8.05 - 9.95）。
每次心力衰竭或心血管事件都会使死亡风险逐步且独立地增加。既往事件的数量可预测死亡率，心力衰竭患者应明确这一点。
