非心脏合并症对射血分数保留与降低的心衰患者（主要为男性）发病率和死亡率的影响。
Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction.
机构信息
Baylor College of Medicine, Houston, Texas, USA.
出版信息
J Am Coll Cardiol. 2012 Mar 13;59(11):998-1005. doi: 10.1016/j.jacc.2011.11.040.
OBJECTIVES
The aim of this study was to evaluate the prevalence and prognostic impacts of noncardiac comorbidities in patients with heart failure (HF) with preserved ejection fraction (HFpEF) compared with those with HF with reduced ejection fraction (HFrEF).
BACKGROUND
There is a paucity of information on the comparative prognostic significance of comorbidities between patients with HFpEF and those with HFrEF.
METHODS
In a national ambulatory cohort of veterans with HF, the comorbidity burden of 15 noncardiac comorbidities and the impacts of these comorbidities on hospitalization and mortality were compared between patients with HFpEF and those with HFrEF.
RESULTS
The cohort consisted of 2,843 patients with HFpEF and 6,599 with HFrEF with 2-year follow-up. Compared with patients with HFrEF, those with HFpEF were older and had higher prevalence of chronic obstructive pulmonary disease, diabetes, hypertension, psychiatric disorders, anemia, obesity, peptic ulcer disease, and cancer but a lower prevalence of chronic kidney disease. Patients with HFpEF had lower HF hospitalization, higher non-HF hospitalization, and similar overall hospitalization compared with those with HFrEF (p < 0.001, p < 0.001, and p = 0.19, respectively). An Increasing number of noncardiac comorbidities was associated with a higher risk for all-cause admissions (p < 0.001). Comorbidities had similar impacts on mortality in patients with HFpEF compared with those with HFrEF, except for chronic obstructive pulmonary disease, which was associated with a higher hazard (1.62 [95% confidence interval: 1.36 to 1.92] vs. 1.23 [95% confidence interval: 1.11 to 1.37], respectively, p = 0.01 for interaction) in patients with HFpEF.
CONCLUSIONS
There is a higher noncardiac comorbidity burden associated with higher non-HF hospitalizations in patients with HFpEF compared with those with HFrEF. However, individually, most comorbidities have similar impacts on mortality in both groups. Aggressive management of comorbidities may have an overall greater prognostic impact in HFpEF compared to HFrEF.
目的
本研究旨在评估射血分数保留型心力衰竭（HFpEF）患者与射血分数降低型心力衰竭（HFrEF）患者相比，非心脏合并症的患病率和预后影响。
背景
关于 HFpEF 患者与 HFrEF 患者之间合并症的比较预后意义，相关信息有限。
方法
在一项针对退伍军人 HF 的全国门诊队列研究中，比较了 HFpEF 患者和 HFrEF 患者的 15 种非心脏合并症的合并症负担，以及这些合并症对住院和死亡率的影响。
结果
该队列包括 2843 例 HFpEF 患者和 6599 例 HFrEF 患者，随访时间为 2 年。与 HFrEF 患者相比，HFpEF 患者年龄更大，慢性阻塞性肺疾病、糖尿病、高血压、精神障碍、贫血、肥胖、消化性溃疡病和癌症的患病率更高，但慢性肾脏病的患病率较低。与 HFrEF 患者相比，HFpEF 患者 HF 住院率较低，非 HF 住院率较高，总住院率相似（均 P < 0.001，P < 0.001，P = 0.19）。非心脏合并症的数量增加与全因入院风险增加相关（P < 0.001）。除慢性阻塞性肺疾病外，合并症对 HFpEF 患者与 HFrEF 患者的死亡率有相似的影响，慢性阻塞性肺疾病与较高的死亡率相关（1.62 [95%置信区间：1.36 至 1.92]与 1.23 [95%置信区间：1.11 至 1.37]，P = 0.01 交互作用）。
结论
与 HFrEF 患者相比，HFpEF 患者的非心脏合并症负担更高，非 HF 住院率更高。然而，就个体而言，大多数合并症对两组患者的死亡率有相似的影响。与 HFrEF 相比，HFpEF 中合并症的积极管理可能对预后有更大的总体影响。
Zotero 插件