From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain.
QJM. 2014 Dec;107(12):989-94. doi: 10.1093/qjmed/hcu127. Epub 2014 Jun 16.
We sought to identify the comorbidities associated with heart failure (HF) in a non-selected cohort of patients, and its influence on mortality and rehospitalization.
Data were obtained from the 'Registro de Insuficiencia Cardiaca' (RICA) of the Spanish Society of Internal Medicine. The registry includes patients prospectively admitted in Internal Medicine units for acute HF. Variables included in Charlson Index (ChI) were collected and analysed according to age, gender, left ventricular ejection fraction (LVEF) and Barthel Index. The primary end point of study was the likelihood of rehospitalization and death for any cause during the year after discharge.
We included 2051 patients, mean age 78 and 53% females. LVEF was ⩾ 50% in 59.1% of the cohort. There was a high degree of dependency as measured by Barthel Index (14.8 % had an index ≤ 60). Mean ChI was 2.91 (SD ± 2.4). The most frequent comorbidities included in ChI were diabetes mellitus (44.3%), chronic renal impairment (30.8%) and chronic obstructive pulmonary disease (COPD) (27.4%). Age, myocardial infarction, peripheral artery disease, dementia, COPD, chronic renal impairment and diabetes with target-organ damage were all identified as independent prognostic factors for the combined end point of rehospitalization and death at 1 year. However, if multivariate analysis was done including ChI, only this remained as an independent prognostic factor for the combined end point (P < 0.001).
HF is a comorbid condition. ChI is a simple and feasible tool for estimating the burden of comorbidities in such population. We believe that a holistic approach to HF would improve prognosis and the relief the pressure exerted on public health services.
我们旨在确定非选择性心力衰竭（HF）患者群体中的合并症，并研究其对死亡率和再住院率的影响。
数据来自西班牙内科学会的“心力衰竭登记（RICA）”。该登记包括因急性 HF 而被前瞻性收治在内科病房的患者。根据年龄、性别、左心室射血分数（LVEF）和巴氏量表收集和分析 Charlson 指数（ChI）中包含的变量。研究的主要终点是出院后 1 年内因任何原因再住院和死亡的可能性。
我们纳入了 2051 名患者，平均年龄为 78 岁，53%为女性。该队列中 59.1%的患者 LVEF ⩾ 50%。巴氏量表测量的患者依赖性程度较高（14.8%的患者指数 ⩽ 60）。ChI 的平均值为 2.91（标准差 ± 2.4）。ChI 中最常见的合并症包括糖尿病（44.3%）、慢性肾功能不全（30.8%）和慢性阻塞性肺疾病（COPD）（27.4%）。年龄、心肌梗死、外周动脉疾病、痴呆、COPD、慢性肾功能不全和伴有靶器官损害的糖尿病均被确定为 1 年时再住院和死亡联合终点的独立预后因素。然而，如果在包括 ChI 的多变量分析中进行，只有这一项是联合终点的独立预后因素（P < 0.001）。
HF 是一种合并症。ChI 是一种简单可行的工具，可用于评估此类人群中合并症的负担。我们认为，HF 的整体治疗方法将改善预后并减轻对公共卫生服务的压力。
