小心！警惕安静的小老太太们：10 年心力衰竭伴收缩功能保留患者队列的人口统计学特征、药物治疗、再入院和生存情况。

Caveat anicula! Beware of quiet little old ladies: demographic features, pharmacotherapy, readmissions and survival in a 10-year cohort of patients with heart failure and preserved systolic function.

机构信息

Royal Adelaide Hospital, Adelaide, SA, Australia.

出版信息

Med J Aust. 2010 Jan 4;192(1):9-13.

PMID:20047541

Abstract

OBJECTIVE

To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD).

DESIGN AND SETTING

A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital.

MAIN OUTCOME MEASURES

Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival.

RESULTS

Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; P = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; P < 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; P = 0.004), anaemia (34.3% v 6.3%; P = 0.013) and atrial fibrillation (51.3% v 47.1%; P = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; P = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin-converting enzyme inhibitor (61.9% v 72.5%; P = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; P < 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; P = 0.032), particularly for malignancy (4.2% v 1.8%; P < 0.001) and anaemia (3.9% v 2.3%; P < 0.001). Both groups had the same poor survival rate (P = 0.912).

CONCLUSIONS

Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.

摘要

目的

确定射血分数保留的心力衰竭（HFPSF）是否与左心室收缩功能障碍（LVSD）具有不同的自然病史。

设计和设置

对一家大型三级转诊医院常规收集的 10 年数据（1994 年 7 月 1 日至 2004 年 6 月 30 日期间入院的患者，研究截止日期为 2005 年 6 月 30 日）进行回顾性分析。

主要观察指标

社会人口统计学特征、诊断特征、合并症、药物治疗、再入院率和生存率。

结果

在 2961 例慢性心力衰竭患者中，有 753 例进行了超声心动图检查。其中 189 例（25%）左心室大小和收缩功能正常。与 LVSD 患者相比，HFPSF 患者更常见于女性（62.4%比 38.5%；P = 0.001），社会支持较少，更有可能居住在养老院（17.9%比 7.6%；P < 0.001），肾功能损害的发生率更高（86.7%比 6.2%；P = 0.004）、贫血（34.3%比 6.3%；P = 0.013）和心房颤动（51.3%比 47.1%；P = 0.008），但缺血性心脏病的发生率较低（53.4%比 81.2%；P = 0.001）。HFPSF 患者接受血管紧张素转换酶抑制剂治疗的可能性较小（61.9%比 72.5%；P = 0.008）；卡维地洛在 LVSD 中使用更为频繁（1.5%比 8.8%；P < 0.001）。HFPSF 组的再入院率较高（中位数，2 次入院比 1.5 次入院；P = 0.032），特别是恶性肿瘤（4.2%比 1.8%；P < 0.001）和贫血（3.9%比 2.3%；P < 0.001）。两组的生存率均较差（P = 0.912）。