年轻人和老年人心肌梗死后心力衰竭的发展和进程。
Development and course of heart failure after a myocardial infarction in younger and older people.
机构信息
Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom.
出版信息
J Geriatr Cardiol. 2014 Mar;11(1):1-12. doi: 10.3969/j.issn.1671-5411.2014.01.002.
BACKGROUND
Acute myocardial infarction (AMI) is a common cause of heart failure (HF), which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age.
METHODS
Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were categorised into those aged < 65 years, 65-75 years, and > 75 years.
RESULTS
Of 896 patients, 311, 297 and 288 were aged < 65, 65-75 and >75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 (8%), 68 (23%) and 107 (37%) occurred during the index admission, many associated with acute HF. A further 37 (12%), 63 (21%) and 82 (29%) developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 (24%), 55 (40%) and 37 (47%) patients developed HF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 (70%), 93 (91%) and 107 (85%) in aged < 65 years, 65-75 years and >75 years, respectively.
CONCLUSIONS
The risk of developing HF and of dying after an MI increases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.
背景
急性心肌梗死（AMI）是心力衰竭（HF）的常见病因，可在 AMI 后不久发生，并可能持续存在或消退或迟发。MI 后的 HF 是死亡的主要原因。不同年龄组 MI 后 HF 的累积发生率、患病率和消退情况描述较差。本研究根据年龄描述 AMI 后 HF 的自然史。
方法
从医院记录中确定 1998 年发生 AMI 的患者。HF 定义为使用袢利尿剂治疗 HF 的症状和体征，如果停止袢利尿剂治疗而无症状复发，则认为已消退。将患者分为<65 岁、65-75 岁和>75 岁。
结果
在 896 例患者中，分别有 311、297 和 288 例年龄<65、65-75 和>75 岁，其中分别有 24%、57%和 82%在 2005 年 12 月前死亡。在这些死亡中，24 例（8%）、68 例（23%）和 107 例（37%）发生在指数入院期间，许多与急性 HF 相关。另有 37 例（12%）、63 例（21%）和 82 例（29%）在出院时持续存在 HF，其中 15 例、44 例和 62 例随后死亡。出院后，分别有 53 例（24%）、55 例（40%）和 37 例（47%）首次出现 HF，其中 26%、62%和 76%随后死亡。在<65 岁、65-75 岁和>75 岁的患者中，分别有 35 例（70%）、93 例（91%）和 107 例（85%）在死亡前发生了 HF。
结论
发生 HF 和 MI 后死亡的风险随年龄增长而逐渐增加。无论年龄大小，MI 后大多数死亡都发生在 HF 之前。
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