患者在心力衰竭中的预后是否比癌症更差？一项基于初级保健的队列研究，在苏格兰进行了 10 年随访。

Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland.

机构信息

Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.

Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK.

出版信息

Eur J Heart Fail. 2017 Sep;19(9):1095-1104. doi: 10.1002/ejhf.822. Epub 2017 May 3.

DOI:10.1002/ejhf.822

PMID:28470962

Abstract

AIMS

This study was designed to evaluate whether survival rates in patients with heart failure (HF) are better than those in patients with diagnoses of the four most common cancers in men and women, respectively, in a contemporary primary care cohort in the community in Scotland.

METHODS AND RESULTS

Data were obtained from the Primary Care Clinical Informatics Unit from a database of 1.75 million people registered with 393 general practices in Scotland. Sex-specific survival modelling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56 658 subjects were eligible for inclusion in the study. These represented a total of 147 938 person-years of follow-up (median follow-up: 2.04 years). In men, HF (reference group; 5-year survival: 55.8%) had worse mortality outcomes than prostate cancer [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.57-0.65; 5-year survival: 68.3%], and bladder cancer (HR 0.88, 95% CI 0.81-0.96; 5-year survival: 57.3%), but better outcomes than lung cancer (HR 3.86, 95% CI 3.65-4.07; 5-year survival: 8.4%) and colorectal cancer (HR 1.23, 95% CI 1.16-1.31; 5-year survival: 48.9%). In women, HF (reference group; 5-year survival: 49.5%) had worse mortality outcomes than breast cancer (HR 0.55, 95% CI 0.51-0.59; 5-year survival 77.7%), but better outcomes than colorectal cancer (HR 1.21, 95% CI 1.13-1.29; 5-year survival 51.5%), lung cancer (HR 3.82, 95% CI 3.60-4.05; 5-year survival 10.4%), and ovarian cancer (HR 1.98, 95% CI 1.80-2.17; 5-year survival 38.2%).

CONCLUSIONS

Despite advances in management, HF remains as 'malignant' as some of the common cancers in both men and women.

摘要

目的

本研究旨在评估在苏格兰社区的一家基层医疗机构的当代普通人群队列中，心力衰竭（HF）患者的生存率是否优于男性和女性中四种最常见癌症患者的生存率。

方法和结果

数据来自苏格兰 393 家全科诊所的 175 万人的初级保健临床信息学单元数据库。使用 Cox 比例风险模型进行了性别特异性生存建模，调整了潜在的混杂因素。共有 56658 名受试者符合纳入研究的条件。这些人共随访了 147938 人年（中位随访时间：2.04 年）。在男性中，HF（参考组；5 年生存率：55.8%）的死亡率比前列腺癌[风险比（HR）0.61，95%置信区间（CI）0.57-0.65；5 年生存率：68.3%]和膀胱癌（HR 0.88，95%CI 0.81-0.96；5 年生存率：57.3%）更差，但比肺癌（HR 3.86，95%CI 3.65-4.07；5 年生存率：8.4%）和结直肠癌（HR 1.23，95%CI 1.16-1.31；5 年生存率：48.9%）更好。在女性中，HF（参考组；5 年生存率：49.5%）的死亡率比乳腺癌（HR 0.55，95%CI 0.51-0.59；5 年生存率：77.7%）更差，但比结直肠癌（HR 1.21，95%CI 1.13-1.29；5 年生存率：51.5%）、肺癌（HR 3.82，95%CI 3.60-4.05；5 年生存率：10.4%）和卵巢癌（HR 1.98，95%CI 1.80-2.17；5 年生存率：38.2%）更好。