按心肌病病因分层的心力衰竭住院患者的特征、治疗和结局。
Characteristics, Treatments, and Outcomes of Hospitalized Heart Failure Patients Stratified by Etiologies of Cardiomyopathy.
机构信息
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Duke Clinical Research Institute, Durham, North Carolina.
出版信息
JACC Heart Fail. 2015 Nov;3(11):906-16. doi: 10.1016/j.jchf.2015.06.012. Epub 2015 Oct 7.
OBJECTIVES
The authors sought to describe characteristics, treatments, and in-hospital outcomes of hospitalized heart failure (HF) patients stratified by etiology.
BACKGROUND
Whether characteristics and outcomes of HF patients differ by cardiomyopathy etiology is unknown.
METHODS
The authors analyzed data on 156,013 hospitalized HF patients from 319 U.S. hospitals participating in Get With The Guidelines-HF between 2005 and 2013. Characteristics, treatments, and in-hospital outcomes were assessed by HF etiology. Standard regression techniques adjusted for site and patient-level characteristics were used to examine association between HF etiology and in-hospital outcomes.
RESULTS
Median age was 75 years, 69.2% were white, and 49.5% were women. Overall, 92,361 patients (59.2%) had ischemic cardiomyopathy and 63,652 patients (40.8%) had nonischemic cardiomyopathy (NICM). Hypertensive (n = 28,141; 48.5%) and idiopathic (n = 17,808; 30.7%) cardiomyopathies accounted for the vast majority of NICM patients. Post-partum (n = 209; 0.4%), viral (n = 447; 0.8%), chemotherapy (n = 721; 1.2%), substance abuse (n = 2,653; 4.6%), familial (n = 556; 1.0%), and other (n = 7,523; 13.0%) etiologies were far less frequent. There were significant differences in baseline characteristics between those with ischemic cardiomyopathy compared with NICM with respect to age (76 years vs. 72 years), sex (44.4% vs. 56.9% women), and ejection fraction (38% vs. 45%). Risk-adjusted quality of care provided to eligible patients varied minimally by etiology. Similarly, in-hospital mortality did not differ among ischemic compared with NICM patients. However, among NICM patients, only hypertensive cardiomyopathy had a lower mortality rate compared with idiopathic NICM (adjusted odds ratio: 0.83; 95% confidence interval: 0.71 to 0.97).
CONCLUSIONS
Characteristics of hospitalized HF patients vary by etiology. Both risk-adjusted quality of care and in-hospital outcomes did not differ by etiology.
目的
作者试图描述按病因分层的住院心力衰竭（HF）患者的特征、治疗方法和住院结局。
背景
HF 患者的特征和结局是否因心肌病病因而异尚不清楚。
方法
作者分析了 2005 年至 2013 年期间，319 家美国医院参与 Get With The Guidelines-HF 项目的 156013 名住院 HF 患者的数据。按 HF 病因评估特征、治疗方法和住院结局。采用标准回归技术，根据地点和患者特征调整，以检查 HF 病因与住院结局之间的关联。
结果
中位年龄为 75 岁，69.2%为白人，49.5%为女性。共有 92361 名患者（59.2%）患有缺血性心肌病，63652 名患者（40.8%）患有非缺血性心肌病（NICM）。高血压性（n=28141；48.5%）和特发性（n=17808；30.7%）心肌病占 NICM 患者的绝大多数。产后（n=209；0.4%）、病毒性（n=447；0.8%）、化疗（n=721；1.2%）、药物滥用（n=2653；4.6%）、家族性（n=556；1.0%）和其他（n=7523；13.0%）病因则少见得多。与缺血性心肌病患者相比，NICM 患者在基线特征方面存在显著差异，包括年龄（76 岁 vs. 72 岁）、性别（44.4% vs. 56.9%女性）和射血分数（38% vs. 45%）。对于符合条件的患者，提供的合格治疗质量的风险调整在病因之间差异极小。同样，缺血性与 NICM 患者之间的住院死亡率也没有差异。然而，在 NICM 患者中，只有高血压性心肌病的死亡率低于特发性 NICM（校正比值比：0.83；95%置信区间：0.71 至 0.97）。
结论
住院 HF 患者的特征因病因而异。风险调整后的治疗质量和住院结局均不因病因而异。
Zotero 插件