因急性心力衰竭住院患者的临床表型和结局：ESC 心力衰竭长期注册研究。
Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry.
机构信息
University of Medicine Carol Davila, Bucuresti; Institutul de Urgente Boli Cardiovasculare C.C. Iliescu, Bucuresti, Romania.
University Paris Diderot, Sorbonne Paris Cité, Paris, France; 4APHP, Department of Anaesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France.
出版信息
Eur J Heart Fail. 2017 Oct;19(10):1242-1254. doi: 10.1002/ejhf.890. Epub 2017 Apr 30.
AIMS
To identify differences in clinical epidemiology, in-hospital management and 1-year outcomes among patients hospitalized for acute heart failure (AHF) and enrolled in the European Society of Cardiology Heart Failure Long-Term (ESC-HF-LT) Registry, stratified by clinical profile at admission.
METHODS AND RESULTS
The ESC-HF-LT Registry is a prospective, observational study collecting hospitalization and 1-year follow-up data from 6629 AHF patients. Among AHF patients enrolled in the registry, 13.2% presented with pulmonary oedema (PO), 2.9% with cardiogenic shock (CS), 61.1% with decompensated heart failure (DHF), 4.8% with hypertensive heart failure (HT-HF), 3.5% with right heart failure (RHF) and 14.4% with AHF and associated acute coronary syndromes (ACS-HF). The 1-year mortality rate was 28.1% in PO, 54.0% in CS, 27.2% in DHF, 12.8% in HT-HF, 34.0% in RHF and 20.6% in ACS-HF patients. When patients were classified by systolic blood pressure (SBP) at initial presentation, 1-year mortality was 34.8% in patients with SBP <85 mmHg, 29.0% in those with SBP 85-110 mmHg, 21.2% in patients with SBP 110-140 mmHg and 17.4% in those with SBP >140 mmHg. These differences tended to diminish in the months post-discharge, and 1-year mortality for the patients who survived at least 6 months post-discharge did not vary significantly by either clinical profile or SBP classification.
CONCLUSION
Rates of adverse outcomes in AHF remain high, and substantial differences have been found when patients were stratified by clinical profile or SBP. However, patients who survived at least 6 months post-discharge represent a more homogeneous group and their 1-year outcome is less influenced by clinical profile or SBP at admission.
目的
通过欧洲心脏病学会心力衰竭长期（ESC-HF-LT）注册研究，根据入院时的临床特征对因急性心力衰竭（AHF）住院并登记的患者进行分层，以确定其在临床流行病学、住院期间管理和 1 年结局方面的差异。
方法和结果
ESC-HF-LT 注册研究是一项前瞻性、观察性研究，从 6629 例 AHF 患者中收集住院和 1 年随访数据。在该注册研究中，13.2%的 AHF 患者表现为肺水肿（PO），2.9%为心源性休克（CS），61.1%为失代偿性心力衰竭（DHF），4.8%为高血压性心力衰竭（HT-HF），3.5%为右心衰竭（RHF），14.4%为 AHF 合并急性冠状动脉综合征（ACS-HF）。PO 患者的 1 年死亡率为 28.1%，CS 患者为 54.0%，DHF 患者为 27.2%，HT-HF 患者为 12.8%，RHF 患者为 34.0%，ACS-HF 患者为 20.6%。当根据入院时的收缩压（SBP）对患者进行分类时，SBP<85mmHg 的患者 1 年死亡率为 34.8%，SBP85-110mmHg 的患者为 29.0%，SBP110-140mmHg 的患者为 21.2%，SBP>140mmHg 的患者为 17.4%。这些差异在出院后几个月内趋于减小，出院后至少存活 6 个月的患者 1 年死亡率与临床特征或 SBP 分类无显著差异。
结论
AHF 的不良结局发生率仍然很高，根据临床特征或 SBP 对患者进行分层时，发现了显著差异。然而，至少存活 6 个月的出院患者代表了一个更为同质的群体，他们的 1 年结局受入院时临床特征或 SBP 的影响较小。
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