既往有卒中病史且因心力衰竭住院患者的临床特征、诱发因素、管理及预后：来自中东地区的一项观察性报告
Clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with heart failure: an observational report from the Middle East.
作者信息
Khafaji Hadi A R, Sulaiman Kadhim, Singh Rajvir, AlHabib Khalid F, Asaad Nidal, Alsheikh-Ali Alawi, Al-Jarallah Mohammed, Bulbanat Bassam, AlMahmeed Wael, Ridha Mustafa, Bazargani Nooshin, Amin Haitham, Al-Motarreb Ahmed, AlFaleh Hussam, Elasfar Abdelfatah, Panduranga Prashanth, Al Suwaidi Jassim
机构信息
Department of Cardiology, Saint Michael's Hospital, Toronto University, Canada.
Department of Cardiology, Royal Hospital, Muscat, Oman.
出版信息
BMJ Open. 2015 Apr 23;5(4):e007148. doi: 10.1136/bmjopen-2014-007148.
OBJECTIVES
The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF).
DESIGN
Retrospective analysis of prospectively collected data.
SETTING
Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared.
PARTICIPANTS
A total of 5005 patients with HF.
OUTCOME MEASURES
In-hospital and 1-year outcome.
RESULTS
The prevalence of prior stroke in patients with HF was 8.1%. Patients with stroke with HF were more likely to be admitted under the care of internists rather than cardiologists. When compared with patients without stroke, patients with stroke were more likely to be older and to have diabetes mellitus, hypertension, atrial fibrillation, hyperlipidaemia, chronic kidney disease, ischaemic heart disease, peripheral arterial disease and left ventricular dysfunction (p=0.001 for all). Patients with stroke were less likely to be smokers (0.003). There were no significant differences in terms of precipitating risk factors for HF hospitalisation between the two groups. Patients with stroke with HF had a longer hospital stay (mean±SD days; 11±14 vs 9±13, p=0.03), higher risk of recurrent strokes and 1-year mortality rates (32.7% vs 23.2%, p=0.001). Multivariate logistic regression analysis showed that stroke is an independent predictor of in-hospital and 1-year mortality.
CONCLUSIONS
This observational study reports high prevalence of prior stroke in patients hospitalised with HF. Internists rather than cardiologists were the predominant caregivers in this high-risk group. Patients with stroke had higher risk of in-hospital recurrent strokes and long-term mortality rates.
TRIAL REGISTRATION NUMBER
NCT01467973.
目的
本研究旨在报告既往有卒中史且因急性心力衰竭（HF）住院患者的患病率、临床特征、诱发因素、治疗及预后情况。
设计
对前瞻性收集的数据进行回顾性分析。
背景
数据源自海湾地区急性心力衰竭注册研究（Gulf CARE），这是一项对2012年在中东七个国家因急性HF连续住院患者进行的前瞻性多中心研究，并根据既往是否有卒中史进行分析；比较了人口统计学、治疗及预后情况。
参与者
共5005例HF患者。
观察指标
住院期间及1年的预后情况。
结果
HF患者中既往有卒中史的患病率为8.1%。合并卒中的HF患者更有可能在内科医生而非心脏病专家的照料下入院。与无卒中患者相比，合并卒中的患者年龄更大，更易患糖尿病、高血压、心房颤动、高脂血症、慢性肾脏病、缺血性心脏病、外周动脉疾病及左心室功能障碍（所有p值均为0.001）。合并卒中的患者吸烟可能性较小（p = 0.003）。两组间HF住院的诱发危险因素无显著差异。合并卒中的HF患者住院时间更长（均值±标准差，天；11±14对9±13，p = 0.03），复发性卒中风险及1年死亡率更高（32.7%对23.2%，p = 0.001）。多因素逻辑回归分析显示，卒中是住院期间及1年死亡率的独立预测因素。
结论
这项观察性研究报告了因HF住院患者中既往有卒中史的高患病率。在这个高危群体中，主要照料者是内科医生而非心脏病专家。合并卒中的患者住院期间复发性卒中风险及长期死亡率更高。
试验注册号
NCT01467973。
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