Setoguchi Masahiko, Hashimoto Yuji, Sasaoka Taro, Ashikaga Takashi, Isobe Mitsuaki
Department of Cardiology, Kameda General Hospital, Kamogawa, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Heart Vessels. 2015 Sep;30(5):595-603. doi: 10.1007/s00380-014-0532-5. Epub 2014 Jun 17.
Although there have been several studies regarding heart failure with preserved ejection fraction (HFpEF), investigations of the risk factors for readmission of Japanese patients with HFpEF remain scarce. Therefore, our goal was to identify the risk factors for readmission of Japanese patients with heart failure (HF), particularly those with HFpEF. We analyzed 310 patients who were hospitalized for the first time with HF. Preserved EF was defined EF ≥50 %, and reduced EF (rEF) was EF <50 %. The study endpoint was readmission for HF after discharge. Medical history, vital signs, electrocardiograms, chest radiographs, blood tests and echocardiograms were compared between patients with HFpEF and with HFrEF. Among the 142 patients who had HFpEF, 43 reached the endpoint within 1 year. Multivariate analysis revealed depression (HR: 7.185), high brain natriuretic peptide (BNP) levels at discharge (HR: 1.003), and dilated inferior vena cava (HR: 1.100) as independent risk factors for readmission. In contrast, 39 of the 168 patients with HFrEF reached the endpoint. Risk factors for readmission of HFrEF patients were low sodium (HR: 0.856), high blood urea nitrogen (HR: 1.045), high BNP levels at discharge (HR: 1.003) and absence of beta-blocker prescription (HR: 0.395). In conclusion, our study suggests that the predictors of HF readmission differ between HFpEF and HFrEF patients.
尽管已有多项关于射血分数保留的心力衰竭（HFpEF）的研究，但针对日本HFpEF患者再入院风险因素的调查仍然较少。因此，我们的目标是确定日本心力衰竭（HF）患者，尤其是HFpEF患者再入院的风险因素。我们分析了310例首次因HF住院的患者。射血分数保留定义为EF≥50%，射血分数降低（rEF）为EF<50%。研究终点是出院后因HF再次入院。比较了HFpEF患者和HFrEF患者的病史、生命体征、心电图、胸部X光片、血液检查和超声心动图。在142例HFpEF患者中，43例在1年内达到终点。多因素分析显示，抑郁（HR：7.185）、出院时高脑钠肽（BNP）水平（HR：1.003）和下腔静脉扩张（HR：1.100）是再入院的独立风险因素。相比之下，168例HFrEF患者中有39例达到终点。HFrEF患者再入院的风险因素为低钠（HR：0.856）、高血尿素氮（HR：1.045）、出院时高BNP水平（HR：1.003）和未开具β受体阻滞剂处方（HR：0.395）。总之，我们的研究表明，HFpEF患者和HFrEF患者HF再入院的预测因素有所不同。
