Kingery Justin R, Yango Missana, Wajanga Bahati, Kalokola Fredrick, Brejt Josef, Kataraihya Johannes, Peck Robert
Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania; Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA; Center for Global Health, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA.
Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania.
Int J Cardiol. 2017 Sep 15;243:311-317. doi: 10.1016/j.ijcard.2017.05.025. Epub 2017 May 9.
To determine one-year, post-hospital mortality and the predictors of mortality in Tanzanian adults with heart failure (HF) compared to other admitted adults.
In this prospective cohort study we consecutively enrolled medical inpatients admitted during a 3-month period, screened for HF and followed until 12 months after hospital discharge. Standardized history, physical examination, echocardiography and laboratory investigations were obtained during hospital presentation. The primary outcome was one-year post-discharge mortality. The secondary outcome was in-hospital mortality. Cox regression adjusted for age and sex was used.
During the study period, we enrolled 558 adults; 145 had HF and 107 of these survived until discharge. Patients with HF had a higher one-year post-hospital discharge mortality than all other diagnoses (62/107 (57.9%) vs 150/343 (43.7%), respectively, HR=1.57[1.13-2.18]). In-hospital mortality was similar. Markers of renal disease were more common in adults with HF (40/107 (37.4%) and were the strongest independent predictors of post-hospital mortality: low eGFR (HR=2.94[1.62-5.31]) and proteinuria (HR=2.03, [95%CI 1.13-3.66]). No patients discharged with the combination of low eGFR/proteinuria survived to the one-year endpoint. Of note, 79/145 (54.5%) of adults admitted with HF were newly diagnosed during hospital admission.
Over half of adults discharged with HF died within 12months after discharge. Adults with HF had higher post-hospital mortality compared to other medical inpatients. Markers of renal disease were the strongest predictor of this mortality. Innovative interventions are needed to reduce post-hospital mortality in adults with HF and should focus on those with renal disease.
确定坦桑尼亚心力衰竭（HF）成年患者与其他入院成年患者相比的1年院后死亡率及死亡预测因素。
在这项前瞻性队列研究中，我们连续纳入了在3个月期间入院的内科住院患者，对其进行HF筛查，并随访至出院后12个月。在患者住院期间获取标准化病史、体格检查、超声心动图和实验室检查结果。主要结局是出院后1年死亡率。次要结局是住院死亡率。使用经年龄和性别调整的Cox回归分析。
在研究期间，我们纳入了558名成年人；其中145人患有HF，其中107人存活至出院。HF患者出院后1年死亡率高于所有其他诊断的患者（分别为62/107（57.9%）和150/343（43.7%），HR=1.57[1.13 - 2.18]）。住院死亡率相似。肾病标志物在HF成年患者中更常见（40/107（37.4%）），并且是院后死亡率最强的独立预测因素：低估算肾小球滤过率（eGFR）（HR=2.94[1.62 - 5.31]）和蛋白尿（HR=2.03，[95%CI 1.13 - 3.66]）。没有低eGFR/蛋白尿组合出院的患者存活至1年终点。值得注意的是，79/145（54.5%）的HF成年入院患者是在住院期间新诊断的。
超过一半的HF出院成年患者在出院后12个月内死亡。与其他内科住院患者相比，HF成年患者的院后死亡率更高。肾病标志物是这种死亡率最强的预测因素。需要创新干预措施以降低HF成年患者的院后死亡率，并且应关注患有肾病的患者。
