Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Int J Cardiol. 2013 Jul 31;167(2):442-50. doi: 10.1016/j.ijcard.2012.01.014. Epub 2012 Feb 2.
Prognosis of chronic patients with established ischemic heart disease (IHD) is not fully understood. The objective was to determine which factors are related to cardiovascular death and hospitalizations in patients with IHD within a primary care network.
A cohort study was carried out by 69 primary care providers in Spain in 2007. Participants were followed up for a mean of 2.2 ± 0.3 years. 1095 patients were recruited if they had established (at least 1 year of known disease) IHD (myocardial infarction or and stable or unstable angina). Several hypothesized determinants of cardiovascular mortality were studied, using Cox proportional hazard regression models. Subgroup analysis was also performed for participants without cardiovascular admissions within the last year.
Mean time since first IHD diagnosis was 7.6 ± 6.0 years. Annual all-cause mortality rate was 3.25%, with 44 cardiovascular deaths and 119 cardiovascular admissions. The main prognostic factor for cardiovascular death was previous heart failure (hazard ratio [HR] 4.32, 95% confidence interval [CI] 2.30 to 8.11, p<0.001). Recent cardiovascular admission doubled the risk for death (HR 2.01, CI 1.06 to 3.81, p=0.031). Results showed that use of beta blockers and increased physical activity were the main protective factors. Patients without a recent cardiovascular admission showed previous heart failure as the main significant factor for cardiovascular death.
Patients with chronic IHD in a primary care setting may need a closer follow-up in the presence of previous conditions such as heart failure. Physical activity and treatment with beta blockers were the factors giving these patients the greatest protection.
患有明确缺血性心脏病（IHD）的慢性患者的预后尚不完全清楚。本研究的目的是确定在初级保健网络中，哪些因素与 IHD 患者的心血管死亡和住院相关。
2007 年，西班牙的 69 名初级保健医生进行了一项队列研究。参与者的平均随访时间为 2.2±0.3 年。如果患者患有明确的（至少有 1 年已知疾病）IHD（心肌梗死或稳定性或不稳定性心绞痛），则招募 1095 名患者。使用 Cox 比例风险回归模型研究了心血管死亡率的几个假设决定因素。还对过去 1 年内没有心血管入院的参与者进行了亚组分析。
首次 IHD 诊断后的平均时间为 7.6±6.0 年。全因年死亡率为 3.25%，有 44 例心血管死亡和 119 例心血管入院。心血管死亡的主要预后因素是既往心力衰竭（危险比 [HR] 4.32，95%置信区间 [CI] 2.30 至 8.11，p<0.001）。近期心血管入院使死亡风险增加了一倍（HR 2.01，CI 1.06 至 3.81，p=0.031）。结果表明，β受体阻滞剂的使用和体力活动的增加是主要的保护因素。没有近期心血管入院的患者，既往心力衰竭是心血管死亡的主要显著因素。
在初级保健环境中患有慢性 IHD 的患者，如果存在心力衰竭等既往疾病，可能需要更密切的随访。体力活动和β受体阻滞剂治疗是使这些患者得到最大保护的因素。
