Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany.
IGES Institut GmbH, Berlin, Germany.
Clin Res Cardiol. 2018 Jun;107(6):487-497. doi: 10.1007/s00392-018-1210-x. Epub 2018 Feb 5.
Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference.
We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005-2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated.
777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9-359.8) and 86.1 (95% CI 70.0-102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5-230.9) and 61.5 (95% CI 52.9-70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7).
Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.
射血分数降低的心衰（HFrEF）的预后比射血分数保留的心衰（HFpEF）更差。本研究旨在评估 HFrEF 和 HFpEF 患者的不同合并症特征或心衰特异性机制是否在更大程度上导致了这种差异。
我们将两家医疗保险的数据与一家心脏病诊所医院信息系统的数据进行了关联。2005 年至 2011 年因心衰住院的患者被分为 HFrEF（EF<45%）或 HFpEF（EF≥45%），并根据合并症和药物使用情况与无心衰的对照组进行倾向评分（PS）匹配，以确保患者及其各自的对照组具有相似的合并症特征。通过标准化差异（SDiff）比较患者和对照组中协变量的平衡。计算年龄标准化的 1 年死亡率（MR）及其 95%置信区间（CI）。
777 名 HFrEF 患者（1135 名 HFpEF 患者）与 3446 名（4832 名）对照组进行了 PS 匹配。大多数考虑的变量的 Sdiff<0.1，患者和对照组之间的平衡基本达到。HFrEF 患者和对照组的年龄标准化 1 年每 1000 人死亡率分别为 267.8（95%CI 175.9-359.8）和 86.1（95%CI 70.0-102.3）。HFpEF 患者和对照组的死亡率分别为 166.2（95%CI 101.5-230.9）和 61.5（95%CI 52.9-70.1）。因此，HFrEF 患者和对照组之间的 MR 差异（181.7）高于 HFpEF 患者和对照组之间的差异（104.7）。
鉴于 HF 患者和对照组之间相似的合并症特征，HFrEF 患者死亡率差异较大，表明这些患者的心衰特异性机制起了更大的作用，而 HFpEF 患者的结果表明，合并症的影响更高。
