因心血管原因与非心血管原因住院对射血分数范围内慢性心力衰竭患者后续死亡率的影响。
Influence of hospitalization for cardiovascular versus noncardiovascular reasons on subsequent mortality in patients with chronic heart failure across the spectrum of ejection fraction.
作者信息
Desai Akshay S, Claggett Brian, Pfeffer Marc A, Bello Natalie, Finn Peter V, Granger Christopher B, McMurray John J V, Pocock Stuart, Swedberg Karl, Yusuf Salim, Solomon Scott D
机构信息
From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
出版信息
Circ Heart Fail. 2014 Nov;7(6):895-902. doi: 10.1161/CIRCHEARTFAILURE.114.001567. Epub 2014 Oct 17.
BACKGROUND
Noncardiovascular (non-CV) comorbidities may contribute to hospitalizations in patients with heart failure (HF). We examined the incidence of mortality following hospitalization for cardiovascular (CV) versus non-CV reasons in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program.
METHODS AND RESULTS
First hospitalizations for CV or non-CV reasons during the CHARM trial (N=7599) were related to subsequent risk of all-cause death using time-updated proportional hazards models. Over median 37.7 month follow-up, 2816 subjects (37.1%) were not hospitalized, 2893 (38.1%) were first hospitalized for CV reasons, and 1890 (24.9%) for non-CV reasons. The death rate (per 100 patient-years) among those not hospitalized was 2.8 compared with 17.8 after CV and 16.5 after non-CV hospitalization (both P<0.001 versus not hospitalized). Mortality at 30 days was higher after CV than non-CV hospitalization; however, among 30-day survivors of CV and non-CV hospitalization, rates of subsequent mortality were similar (14.5 versus 14.6 per 100 patient-years; P=0.62). Rates of CV hospitalization were higher for those with ejection fraction (EF) ≤40% than those with EF >40% (P<0.001), but rates of non-CV hospitalization did not vary by EF. Low EF patients had higher risk for mortality than preserved EF patients after any hospitalization, but within each EF subgroup, mortality in 30-day survivors of CV versus non-CV hospitalization was similar.
CONCLUSIONS
Non-CV hospitalization is frequent in patients with symptomatic heart failure and associated with risk of subsequent mortality similar to CV hospitalization across the spectrum of EF. These findings may have implications for developing strategies to prevent readmissions.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00634309 (CHARM-Added), NCT00634712 (CHARM-Preserved), NCT00634400 (CHARM-Alternative).
背景
非心血管（非CV）合并症可能导致心力衰竭（HF）患者住院。我们在心力衰竭坎地沙坦：死亡率和发病率降低评估（CHARM）项目中，研究了因心血管（CV）与非CV原因住院后死亡的发生率。
方法与结果
使用时间更新的比例风险模型，将CHARM试验期间（N = 7599）首次因CV或非CV原因住院与随后全因死亡风险相关联。在中位37.7个月的随访中，2816名受试者（37.1%）未住院，2893名（38.1%）首次因CV原因住院，1890名（24.9%）因非CV原因住院。未住院者的死亡率（每100患者年）为2.8，而CV住院后为17.8，非CV住院后为16.5（与未住院者相比，两者P<0.001）。CV住院后30天的死亡率高于非CV住院；然而，在CV和非CV住院的30天幸存者中，随后的死亡率相似（每100患者年分别为14.5和14.6；P = 0.62）。射血分数（EF）≤40%者的CV住院率高于EF>40%者（P<0.001），但非CV住院率不因EF而异。任何住院后，低EF患者的死亡风险高于保留EF患者，但在每个EF亚组中，CV与非CV住院的30天幸存者的死亡率相似。
结论
有症状心力衰竭患者中非CV住院很常见，且在整个EF范围内，与随后死亡率风险相关，类似于CV住院。这些发现可能对制定预防再入院策略有启示。
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