Gerber Yariv, Weston Susan A, Redfield Margaret M, Chamberlain Alanna M, Manemann Sheila M, Jiang Ruoxiang, Killian Jill M, Roger Véronique L
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
JAMA Intern Med. 2015 Jun;175(6):996-1004. doi: 10.1001/jamainternmed.2015.0924.
Heart failure (HF) is commonly referred to as an epidemic, posing major clinical and public health challenges. Yet, contemporary data on its magnitude and implications are scarce.
To evaluate recent trends in HF incidence and outcomes overall and by preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF).
DESIGN, SETTING, AND PARTICIPANTS: Incidence rates of HF in Olmsted County, Minnesota (population, approximately 144,248), between January 1, 2000, and December 31, 2010, were assessed.
Patients identified with incident HF (n = 2762) (mean age, 76.4 years; 43.1% male) were followed up for all-cause and cause-specific hospitalizations (through December 2012) and death (through March 2014).
The age- and sex-adjusted incidence of HF declined substantially from 315.8 per 100,000 in 2000 to 219.3 per 100,000 in 2010 (annual percentage change, -4.6), equating to a rate reduction of 37.5% (95% CI, -29.6% to -44.4%) over the last decade. The incidence declined for both HF types but was greater (interaction P = .08) for HFrEF (-45.1%; 95% CI, -33.0% to -55.0%) than for HFpEF (-27.9%; 95% CI, -12.9% to -40.3%). Mortality was high (24.4% for age 60 years and 54.4% for age 80 years at 5 years of follow-up), frequently ascribed to noncardiovascular causes (54.3%), and did not decline over time. The risk of cardiovascular death was lower for HFpEF than for HFrEF (multivariable-adjusted hazard ratio, 0.79; 95% CI, 0.67-0.93), whereas the risk of noncardiovascular death was similar (1.07; 95% CI, 0.89-1.29). Hospitalizations were common (mean, 1.34; 95% CI, 1.25-1.44 per person-year), particularly among men, and did not differ between HFpEF and HFrEF. Most hospitalizations (63.0%) were due to noncardiovascular causes. Hospitalization rates for cardiovascular causes did not change over time, whereas those for noncardiovascular causes increased.
Over the last decade, the incidence of HF declined substantially, particularly for HFrEF, contrasting with no apparent change in mortality. Noncardiovascular conditions have an increasing role in hospitalizations and remain the most frequent cause of death. These results underscore the need to augment disease-centric management approaches with holistic strategies to reduce the population burden of HF.
心力衰竭（HF）通常被称为一种流行病，带来了重大的临床和公共卫生挑战。然而，关于其规模和影响的当代数据却很匮乏。
评估心力衰竭发病率及总体预后的近期趋势，以及按射血分数保留（HFpEF）或射血分数降低（HFrEF）分类的情况。
设计、地点和参与者：评估了明尼苏达州奥尔姆斯特德县（人口约144,248）在2000年1月1日至2010年12月31日期间的心力衰竭发病率。
对确诊为新发心力衰竭的患者（n = 2762）（平均年龄76.4岁；43.1%为男性）进行全因和特定病因住院治疗（截至2012年12月）以及死亡情况（截至2014年3月）的随访。
经年龄和性别调整后的心力衰竭发病率从2000年的每10万人315.8例大幅下降至2010年的每10万人219.3例（年百分比变化为-4.6），相当于在过去十年中发病率降低了37.5%（95%置信区间，-29.6%至-44.4%）。两种类型的心力衰竭发病率均下降，但HFrEF的下降幅度更大（交互作用P = 0.08）（-45.1%；95%置信区间，-33.0%至-55.0%），高于HFpEF（-27.9%；95%置信区间，-1至-40.3%）。死亡率较高（随访5年时，60岁患者为24.4%，80岁患者为54.4%），常见原因是非心血管原因（54.3%），且未随时间下降。HFpEF患者心血管死亡风险低于HFrEF患者（多变量调整后的风险比为0.79；95%置信区间，0.67 - 0.93），而非心血管死亡风险相似（1.07；95%置信区间，0.89 - 1.29）。住院情况常见（平均每人每年1.34次；95%置信区间，1.25 - ），男性尤为突出，HFpEF和HFrEF之间无差异。大多数住院（63.0%）是由非心血管原因导致。心血管原因导致的住院率未随时间变化，而非心血管原因导致的住院率上升。
在过去十年中，心力衰竭发病率大幅下降，尤其是HFrEF，而死亡率无明显变化。非心血管疾病在住院治疗中的作用日益增加，仍是最常见的死亡原因。这些结果强调了需要用整体策略加强以疾病为中心的管理方法，以减轻心力衰竭的人群负担。
