Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
School of Public Health, Mekelle University, Mekelle, Ethiopia.
Cardiovasc Ther. 2017 Dec;35(6). doi: 10.1111/1755-5922.12303. Epub 2017 Oct 3.
Available data on the prognosis of heart failure (HF) patients are predominantly limited to patients diagnosed at time of hospitalization.
To describe the long-term survival of incident HF patients and identify clinical characteristics associated with mortality.
The Second Australian National Blood Pressure Study (ANBP2) randomized 6083 hypertensive subjects aged 65-84 years to angiotensin-converting enzyme (ACE) inhibitor or thiazide diuretic-based therapy and followed them for a median of 4.1 years. One hundred forty-five participants who developed HF and 5938 who remained free from HF during the trial period were followed for a median of 6.7 years during a posttrial follow-up.
Three quarters, 110 (76%) of HF patients had died at the end of the follow-up. The five- and ten-year survival rates following HF diagnosis during the trial period were 37% and 15%, respectively, in men, compared with 60% and 33%, respectively, in women. In non-heart failure participants, the five- and ten-year survival rates, following enrollment into the study, were 92% and 76%, respectively. Mortality following HF diagnosis increased with advancing age (HR = 1.09, 95% CI: 1.04-1.33). In addition, male gender and preexisting diabetes were predictive of mortality, while ACE inhibitor-based therapy for the initial trial was associated with 39% decrease (HR = 0.61, 95% CI: 0.41-0.91) in mortality compared with a thiazide diuretic-based regimen.
Long-term survival in elderly HF patients is poor, especially in men. Mortality in HF patients increased progressively with advancing age, while allocation to the ACE inhibitor-based regimen for the initial trial significantly improved HF outcome.
目前关于心力衰竭（HF）患者预后的数据主要局限于住院时确诊的患者。
描述新发 HF 患者的长期生存情况，并确定与死亡率相关的临床特征。
澳大利亚第二项全国血压研究（ANBP2）将 6083 名年龄在 65-84 岁的高血压患者随机分为血管紧张素转换酶（ACE）抑制剂或噻嗪类利尿剂为基础的治疗组，并随访中位数为 4.1 年。在试验期间发生 HF 的 145 名参与者和未发生 HF 的 5938 名参与者在试验期间中位随访 6.7 年后进行了后续随访。
在随访结束时，四分之三，即 110（76%）名 HF 患者死亡。在试验期间诊断为 HF 后，男性患者的 5 年和 10 年生存率分别为 37%和 15%，而女性患者分别为 60%和 33%。在非心力衰竭参与者中，入组研究后的 5 年和 10 年生存率分别为 92%和 76%。HF 诊断后死亡率随年龄增长而增加（HR=1.09，95%CI：1.04-1.33）。此外，男性性别和预先存在的糖尿病是死亡率的预测因素，而最初试验中基于 ACE 抑制剂的治疗与基于噻嗪类利尿剂的方案相比，死亡率降低了 39%（HR=0.61，95%CI：0.41-0.91）。
老年 HF 患者的长期生存率较差，尤其是男性。HF 患者的死亡率随年龄增长而逐渐增加，而最初试验中基于 ACE 抑制剂的治疗方案显著改善了 HF 结局。
