Taylor Clare J, Ryan Ronan, Nichols Linda, Gale Nicola, Hobbs Fd Richard, Marshall Tom
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Fam Pract. 2017 Apr 1;34(2):161-168. doi: 10.1093/fampra/cmw145.
Heart failure is a common long term condition affecting around 900 000 people in the UK and patients commonly present to primary care. The prognosis of patients with a code of heart failure in their primary care record is unknown.
The study sought to determine the overall survival rates for patients with heart failure in a primary care population from the time of diagnosis.
Survival analysis was carried out using UK primary care records from The Health Improvement Network (THIN) between 1 January 1998 and 31 December 2012. Patients age 45 or over with a first diagnostic label of heart failure were matched by age, sex and practice to people without heart failure. Outcome was death in the heart failure and no heart failure cohorts. Kaplan-Meier curves were used to compare survival. Age-specific survival rates at 1, 5 and 10 years were determined for men and women with heart failure. Survival rates by year of diagnosis and case definition were also calculated.
During the study period, 54313 patients had a first diagnostic code of heart failure. Overall survival rates for the heart failure group were 81.3% (95%CI 80.9-81.6), 51.5% (95%CI 51.0-52.0) and 29.5% (95%CI 28.9-30.2) at 1, 5 and 10 years respectively and did not change over time.
In a primary care population, the survival of patients diagnosed with heart failure did not improved over time. Further research is needed to explain these trends and to find strategies to improve outlook.
心力衰竭是一种常见的长期病症，在英国约有90万人受其影响，患者常到初级保健机构就诊。初级保健记录中有心力衰竭诊断代码的患者的预后情况尚不清楚。
本研究旨在确定初级保健人群中心力衰竭患者从诊断时起的总体生存率。
利用健康改善网络（THIN）1998年1月1日至2012年12月31日的英国初级保健记录进行生存分析。年龄在45岁及以上且首次诊断为心力衰竭的患者，按年龄、性别和医疗机构与无心力衰竭的人进行匹配。观察的结局是心力衰竭队列和无心力衰竭队列中的死亡情况。采用Kaplan-Meier曲线比较生存率。确定了心力衰竭男性和女性患者在1年、5年和10年时的年龄特异性生存率。还计算了按诊断年份和病例定义划分的生存率。
在研究期间，54313名患者有首次心力衰竭诊断代码。心力衰竭组的总体生存率在1年、5年和10年时分别为81.3%（95%CI 80.9 - 81.6）、51.5%（95%CI 51.0 - 52.0）和29.5%（95%CI 28.9 - 30.2），且未随时间变化。
在初级保健人群中，诊断为心力衰竭的患者生存率未随时间改善。需要进一步研究来解释这些趋势并找到改善预后的策略。
