Clinical Cardiology, Heart Failure Unit, Istituto Scientifico San Raffaele, Milano, Italy.
J Cardiovasc Med (Hagerstown). 2013 Jan;14(1):57-65. doi: 10.2459/JCM.0b013e32834ae697.
To relate therapeutic issues, comorbidities and functional parameters to mortality/morbidity of mild/moderate heart failure patients.
From our heart failure clinic, 372 heart failure patients (269 men, aged 66 ± 11 years), with stable heart failure and ejection fraction 45% or less were recruited. Survival curves were estimated according to the Kaplan-Meier method. Associations of protective/risk factors with cardiovascular mortality/morbidity were also evaluated.
One hundred and two patients (27%) died (aged 70 ± 10 years at diagnosis, 76 ± 10 at death) during follow-up (overall mortality at 60 months: 19.2%; mean follow-up period: 67 ± 44 months). Cardiovascular deaths were 64 (63% of total deaths, 44 men, age at diagnosis 70 ± 9). Cardiovascular mortality at 60 months was 12%; standardized mortality ratio was 5.9 for women and 6.8 for men. The remaining 38 patients (37% of total deaths, 30 men, age at diagnosis 70 ± 10) died of noncardiovascular causes. Overall, noncardiovascular mortality at 60 months was 7.2%; mean survival time from diagnosis to death was 63 ± 69 months (median 42, Q1 = 27.5, Q3 = 77.7). Average cardiovascular admission rate was 1.63 ± 1.84 admissions/patient. At multivariate analysis, only previous history of myocardial infarction [hazard ratio: 3.62 (1.70-7.73)], class of ejection fraction at diagnosis [hazard ratio: 0.36 (0.32-0.60)], acute cardiac decompensation at any time [hazard ratio: 1.55 (1.32-1.84)], implanted defibrillator [hazard ratio: 0.11 (0.01-0.83)] and use of statins [hazard ratio: 0.08 (0.007-0.42)] were independently associated with cardiovascular mortality. Factors associated to higher annual cardiovascular morbidity were age at diagnosis, chronic renal failure, diabetes, cardiac decompensation at any time, female sex and diuretic therapy. Angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin-receptor-blockers reduced annual cardiovascular morbidity.
Survival in mild/moderate heart failure patients has consistently improved. Further improvements are warranted in terms of morbidity reduction.
探讨治疗问题、合并症和功能参数与轻度/中度心力衰竭患者死亡率/发病率的关系。
从我们的心力衰竭诊所招募了 372 名心力衰竭患者（269 名男性，年龄 66 ± 11 岁），这些患者心力衰竭稳定，射血分数为 45%或更低。根据 Kaplan-Meier 方法估计生存曲线。还评估了保护/危险因素与心血管死亡率/发病率的关系。
102 例患者（27%）在随访期间死亡（诊断时年龄为 70 ± 10 岁，死亡时为 76 ± 10 岁），60 个月时总死亡率为 19.2%，平均随访时间为 67 ± 44 个月。心血管死亡 64 例（占总死亡的 63%，44 例为男性，诊断时年龄为 70 ± 9 岁）。60 个月时心血管死亡率为 12%，女性标准化死亡率比为 5.9，男性为 6.8。其余 38 例患者（占总死亡的 37%，30 例为男性，诊断时年龄为 70 ± 10 岁）死于非心血管原因。总的来说，60 个月时非心血管死亡率为 7.2%，从诊断到死亡的平均生存时间为 63 ± 69 个月（中位数为 42，Q1=27.5，Q3=77.7）。平均心血管入院率为 1.63 ± 1.84 次/患者。多变量分析显示，仅既往心肌梗死史[风险比：3.62（1.70-7.73）]、诊断时射血分数类别[风险比：0.36（0.32-0.60）]、任何时间急性心脏失代偿[风险比：1.55（1.32-1.84）]、植入式除颤器[风险比：0.11（0.01-0.83）]和使用他汀类药物[风险比：0.08（0.007-0.42）]与心血管死亡率独立相关。与较高的年度心血管发病率相关的因素包括诊断时的年龄、慢性肾功能衰竭、糖尿病、任何时候的心脏失代偿、女性和利尿剂治疗。血管紧张素转换酶（ACE）抑制剂和/或血管紧张素受体阻滞剂降低了年度心血管发病率。
轻度/中度心力衰竭患者的生存率持续提高。在降低发病率方面仍需进一步改进。
