Royal Adelaide Hospital, Adelaide, SA, Australia.
Med J Aust. 2010 Jan 4;192(1):9-13.
To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD).
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.
Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival.
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).
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.
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。
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。
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。
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）。
HFPSF 患者主要为年龄较大的女性，社会支持较少，与合并症相关的再入院率较高。因此，我们提出 HFPSF 患者的生存率较低可能与合并症有关，而不是心脏管理不当。
