Gho Johannes M I H, Schmidt Amand F, Pasea Laura, Koudstaal Stefan, Pujades-Rodriguez Mar, Denaxas Spiros, Shah Anoop D, Patel Riyaz S, Gale Chris P, Hoes Arno W, Cleland John G, Hemingway Harry, Asselbergs Folkert W
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK.
Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
BMJ Open. 2018 Mar 3;8(3):e018331. doi: 10.1136/bmjopen-2017-018331.
To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs).
Data were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models.
Of the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation.
In England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.
利用常规收集的初级和医院护理电子健康记录（EHRs），调查当代心肌梗死（MI）患者队列中心力衰竭（HF）的发生率及其决定因素。
使用来自CALIBER项目的数据，该项目将英格兰初级护理、医院入院、心肌梗死登记处和死亡率数据中的电子健康记录相链接。受试者年龄在18岁及以上，无心力衰竭病史且首次心肌梗死存活者符合入选条件。使用Cox比例风险模型检查与发生心力衰竭时间相关的因素。
在24479例心肌梗死患者中，5775例（23.6%）在中位随访3.7年期间发生心力衰竭（每1000人年发病率：63.8，95%可信区间62.2至65.5）。与发生心力衰竭显著相关的基线特征为：心房颤动（风险比1.62，95%可信区间1.51至1.75）、年龄（每增加10岁：1.45，1.41至1.49）、糖尿病（1.45，1.35至1.56）、外周动脉疾病（1.38，1.26至1.51）、慢性阻塞性肺疾病（1.28，1.17至1.40）、社会经济剥夺程度较高（第5五分位数与第1五分位数相比：1.27，1.13至1.41）、就诊时ST段抬高型心肌梗死（1.19，1.11至1.27）和高血压（1.16，1.09至1.23）。各种敏感性分析（如竞争风险分析和多重插补）结果均稳健可靠。
在英格兰地区，首次心肌梗死幸存者中有四分之一在4年内发生心力衰竭。这项当代研究表明，心肌梗死患者发生心力衰竭风险相当高。已确定与发生心力衰竭时间相关的患者基线特征，可用于制定预防策略。
