减重手术与心力衰竭恶化急诊就诊和住院：基于人群的自身对照系列研究。

Bariatric Surgery and Emergency Department Visits and Hospitalizations for Heart Failure Exacerbation: Population-Based, Self-Controlled Series.

机构信息

Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

出版信息

J Am Coll Cardiol. 2016 Mar 1;67(8):895-903. doi: 10.1016/j.jacc.2015.12.016.

DOI:10.1016/j.jacc.2015.12.016

PMID:26916477

Abstract

BACKGROUND

The United States is battling obesity and heart failure (HF) epidemics. Although studies have suggested relationships between obesity and HF morbidity, little is known regarding the effects of substantial weight reduction in obese patients with HF.

OBJECTIVES

This study investigated whether bariatric surgery is associated with a decreased rate of HF exacerbation.

METHODS

We performed a self-controlled case series study of obese patients with HF who underwent bariatric surgery, using the population-based emergency department (ED) and inpatient sample in California, Florida, and Nebraska. Primary outcome was ED visit or hospitalization for HF exacerbation from 2005 to 2011. We used conditional logistic regression to compare the outcome event rate during sequential 12-month periods, using pre-surgery months 13 to 24 as the reference period.

RESULTS

We identified 524 patients with HF who underwent bariatric surgery. During the reference period, 16.2% of patients had an ED visit or hospitalization for HF exacerbation. The rate remained unchanged in the subsequent 12-month pre-surgery period (15.3%; p = 0.67). In the first 12-month period after bariatric surgery, we observed a nonsignificantly reduced rate (12.0%; p = 0.052). However, the rate was significantly lower in the subsequent 13 to 24 months after bariatric surgery (9.9%; adjusted odds ratio: 0.57; p = 0.003). By contrast, there was no significant reduction in the rate of HF exacerbation among obese patients who underwent nonbariatric surgery (i.e., cholecystectomy, hysterectomy).

CONCLUSIONS

Our findings indicate that bariatric surgery is associated with a decline in the rate of HF exacerbation requiring ED evaluation or hospitalization among obese patients with HF.

摘要

背景

美国正在与肥胖和心力衰竭（HF）流行作斗争。尽管有研究表明肥胖与 HF 发病率之间存在关联，但对于肥胖 HF 患者体重显著减轻的影响知之甚少。

目的

本研究旨在探讨减重手术是否与 HF 恶化率降低相关。

方法

我们对在加利福尼亚州、佛罗里达州和内布拉斯加州进行减重手术的肥胖 HF 患者进行了一项基于人群的急诊部（ED）和住院患者的自身对照病例系列研究。主要结局为 2005 年至 2011 年 ED 就诊或 HF 恶化住院。我们使用条件逻辑回归来比较连续 12 个月期间的结局事件发生率，将手术前的 13 至 24 个月作为参考期。

结果

我们确定了 524 名接受减重手术的 HF 患者。在参考期内，有 16.2%的患者因 HF 恶化而进行 ED 就诊或住院治疗。在随后的 12 个月术前期间，该比率保持不变（15.3%；p=0.67）。在减重手术后的第一个 12 个月期间，我们观察到一个无显著降低的比率（12.0%；p=0.052）。然而，在减重手术后的 13 至 24 个月期间，该比率显著降低（9.9%；校正后的优势比：0.57；p=0.003）。相比之下，在接受非减重手术（即胆囊切除术、子宫切除术）的肥胖患者中，HF 恶化的发生率并没有显著降低。