2002 年至 2009 年因心力衰竭和慢性阻塞性肺疾病住院患者的结局：临床特征和治疗的差异。
Outcomes in patients hospitalized for heart failure and chronic obstructive pulmonary disease: differences in clinical profile and treatment between 2002 and 2009.
机构信息
Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
出版信息
Eur J Heart Fail. 2016 Jul;18(7):840-8. doi: 10.1002/ejhf.519. Epub 2016 Apr 21.
AIMS
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently co-exist, and each is a major public health issue. In a large cohort of hospitalized HF patients, we evaluated: (i) the impact of COPD on clinical outcomes; (ii) whether outcomes and treatments changed from 2002 to 2009; and (iii) the relationship between outcomes and treatments focusing on beta-blockers (BBs) and bronchodilators (BDs).
METHODS AND RESULTS
From linkable Lombardy administrative health databases, we selected individuals with a discharge diagnosis of HF with or without concomitant COPD (HF yesCOPD and HF noCOPD) in 2002 and 2009. Patients were followed up for 4 years. Outcomes were total mortality, first readmission for HF, and their combination. Unadjusted and adjusted Cox proportional models and competing risk analyses were used. We identified 11 274 patients with HF noCOPD and 2837 with HF yesCOPD. HF yesCOPD patients in 2002 and 2009 had a 20% higher risk of the outcomes. From 2002 to 2009, BB and BD prescriptions increased significantly. In HF noCOPD patients, risks for mortality [adjusted hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.86-0.97], first HF readmission (HR 0.79, 95% CI 0.74-0.85), and the combined endpoint (HR 0.88, 95% CI 0.84-0.92) declined (all P < 0.003) while in HF yesCOPD only the risk for first HF readmission dropped (HR 0.86, 95% CI 0.76-0.97; P = 0.018). BBs were associated with significantly lower mortality in both groups, but with a higher risk for first HF readmission in HF noCOPD. Outcomes did not significantly differ in HF yesCOPD treated or not with BDs.
CONCLUSIONS
The prognosis of patients hospitalized for HF, either with or without COPD, seemed to improve between 2002 and 2009, with possibly better survival of those on BBs. Because of residual confounding in observational studies, a randomized controlled trial should be considered to confirm these results.
目的
心力衰竭（HF）和慢性阻塞性肺疾病（COPD）常同时存在，且二者均为重大公共卫生问题。我们在一项大型住院 HF 患者队列中评估了：（i）COPD 对临床结局的影响；（ii）2002 年至 2009 年结局和治疗是否发生变化；（iii）重点关注β受体阻滞剂（BBs）和支气管扩张剂（BDs）的结局与治疗之间的关系。
方法和结果
我们从可链接的伦巴第行政健康数据库中选择 2002 年和 2009 年有或无合并 COPD 的 HF 出院诊断（HF 伴 COPD 和 HF 不伴 COPD）的个体。患者随访 4 年。结局为全因死亡率、HF 首次再入院及两者的联合结局。采用未调整和调整后的 Cox 比例模型和竞争风险分析。我们共纳入 11274 例 HF 不伴 COPD 患者和 2837 例 HF 伴 COPD 患者。HF 伴 COPD 患者在 2002 年和 2009 年的结局风险增加 20%。2002 年至 2009 年，BB 和 BD 的处方量显著增加。在 HF 不伴 COPD 患者中，死亡率[调整后的危险比（HR）0.91，95%置信区间（CI）0.86-0.97]、HF 首次再入院（HR 0.79，95%CI 0.74-0.85）和联合终点（HR 0.88，95%CI 0.84-0.92）均下降（均 P<0.003），而在 HF 伴 COPD 患者中仅首次 HF 再入院的风险下降（HR 0.86，95%CI 0.76-0.97；P=0.018）。BBs 与两组患者的死亡率显著降低相关，但 HF 不伴 COPD 患者的首次 HF 再入院风险更高。HF 伴 COPD 患者无论是否接受 BD 治疗，结局均无显著差异。
结论
2002 年至 2009 年间，HF 住院患者（伴或不伴 COPD）的预后似乎有所改善，可能是因为 BB 治疗的患者生存率更高。由于观察性研究中存在残余混杂，应考虑进行随机对照试验以证实这些结果。
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