婚姻状况对心力衰竭临床结局的影响。

Effect of marital status on clinical outcome of heart failure.

机构信息

Department of Medicine, Section of General Internal Medicine, San Antonio Military Medical Center, San Antonio, TX, USA.

出版信息

J Investig Med. 2013 Jun;61(5):835-41. doi: 10.2310/JIM.0b013e31828c823e.

DOI:10.2310/JIM.0b013e31828c823e

PMID:23524985

Abstract

BACKGROUND

Despite significant advances in pharmacological and nonpharmacological treatment of heart failure (HF), there are more than 1 million HF visits annually to the emergency department. Studies indicate that HF clinical outcome is affected not only by medical interventions but also by social factors such as marital status.

OBJECTIVES

This study aimed to determine the effect of marital status of HF patients on clinical outcome of HF in a high-risk population.

METHODS

We reviewed data collected for The Joint Commission in patients admitted with HF at a university hospital serving a high-risk population in Louisiana during the period from June 2003 to September 2004 and followed up until December 2008. Patients were divided into 2 groups, namely, married patients and unmarried patients (including single, divorced, and widowed) based on self-reporting. Primary outcome measures were in-hospital survival and time to readmission. Secondary outcome measures were HF admission rate, average B-type natriuretic peptide, and average troponin-I levels throughout the follow-up period.

RESULTS

Of 646 reviewed records, 542, representing 357 patients, were included in the analysis. Of these, 105 patients were married and 245 were unmarried; marital status was missing for 7 patients. Mean (SD) of follow-up period was 2.39 (1.6) years. Marital status was not a significant variable for in-hospital death (hazard ratio, 0.71; 95% confidence interval, 0.35-1.49), or for time to readmission for HF (hazard ratio, 1.16; 95% confidence interval, 0.86-1.56); multiple linear regression analysis identified married status as an independent variable for average B-type natriuretic peptide (parameter estimate = -0.26, P = 0.02) but not for HF admission rate or average troponin-I levels.

CONCLUSIONS

Married status was not associated with better clinical outcome in HF patients in a high-risk population.

摘要

背景

尽管心力衰竭（HF）的药物和非药物治疗取得了重大进展，但每年仍有超过 100 万例 HF 患者前往急诊科就诊。研究表明，HF 的临床结果不仅受医疗干预的影响，还受社会因素的影响，如婚姻状况。

目的

本研究旨在确定 HF 患者的婚姻状况对高危人群中 HF 临床结局的影响。

方法

我们回顾了 2003 年 6 月至 2004 年 9 月期间在路易斯安那州一家为高危人群服务的大学医院因 HF 入院的患者的联合委员会收集的数据，并随访至 2008 年 12 月。根据自我报告，患者分为已婚组和未婚组（包括单身、离婚和丧偶）。主要观察指标为住院期间生存率和再入院时间。次要观察指标为 HF 入院率、整个随访期间的平均 B 型利钠肽和平均肌钙蛋白 I 水平。

结果

在 646 份审查记录中，有 542 份（代表 357 名患者）被纳入分析。其中 105 名患者已婚，245 名患者未婚；7 名患者的婚姻状况缺失。平均（SD）随访期为 2.39（1.6）年。婚姻状况不是住院死亡的显著变量（风险比，0.71；95%置信区间，0.35-1.49），也不是 HF 再入院时间的显著变量（风险比，1.16；95%置信区间，0.86-1.56）；多元线性回归分析确定已婚状态是平均 B 型利钠肽的独立变量（参数估计值=-0.26，P=0.02），但不是 HF 入院率或平均肌钙蛋白 I 水平的独立变量。