Eriksson B, Wändell P, Dahlström U, Näsman P, Lund L H, Edner M
a Division of Family Medicine, Department of Neurobiology , Care Sciences and Society (NVS), Karolinska Institutet , Huddinge , Sweden.
b Division of Family Medicine , NVS, Karolinska Institutet , Sweden.
Scand J Prim Health Care. 2018 Jun;36(2):207-215. doi: 10.1080/02813432.2018.1459654. Epub 2018 Apr 10.
The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups.
We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately.
The prospective Swedish Heart Failure Registry.
Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%.
Comorbidities, risk factors and mortality.
Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p < 0.0001, 46.7 vs. 36.3% women respectively (p < 0.0001) and EF ≥50% 26.1 vs. 13.4% (p < 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 31.5% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively.
Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group. KEY POINTS 97% of heart failure patients with an ejection fraction of more than or equal to 40% managed at primary care based out-patient clinics had any comorbidity. Patients in primary care had partly other independent risk factors than those in hospital care. All-cause mortality during mean follow-up of almost 4 years was higher in primary care compared to hospital care. In matched HF-patients RAS-antagonists, beta-blockers as well as the combination of the two drugs were more seldom prescribed when managed in primary care compared with hospital care.
本研究旨在描述射血分数（EF）大于或等于40%的心力衰竭患者，分别在基层和医院门诊进行管理时的预后、合并症及危险因素。进一步比较两组的心力衰竭用药情况。
我们使用前瞻性瑞典心力衰竭登记系统纳入了9654例射血分数≥40%的心力衰竭门诊患者，其中1802例在基层医疗登记，7852例在医院医疗登记。采用描述性统计检验分析两组的基线特征，并采用多因素逻辑回归分析分别评估两组的死亡率。
前瞻性瑞典心力衰竭登记系统。
射血分数大于或等于40%的心力衰竭患者。
合并症、危险因素和死亡率。
平均年龄在基层医疗组为77.5岁，在医院医疗组为70.3岁（p<0.0001）；女性分别为46.7%和36.3%（p<0.0001）；射血分数≥50%的患者分别为26.1%和13.4%（p<0.0001）。两组合并症均常见（97.2%对92.3%），基层医疗组房颤、高血压、缺血性心脏病和慢性阻塞性肺疾病更多。根据多因素逻辑回归分析，吸烟、慢性阻塞性肺疾病和糖尿病是基层医疗组最重要的独立危险因素，而瓣膜病是医院医疗组的最重要独立危险因素。在平均近4年的随访期间，基层医疗组的全因死亡率为31.5%，医院医疗组为27.8%。1年死亡率分别为7.8%和7.0%。
在基层医疗门诊管理的射血分数大于或等于40%的心力衰竭患者中，97%有合并症，这些患者与在医院门诊管理的患者相比，部分有其他独立危险因素。我们的结果表明，在基层医疗组应更重视慢性阻塞性肺疾病的管理。要点：在基层医疗门诊管理的射血分数大于或等于40%的心力衰竭患者中，97%有合并症。基层医疗组患者与医院医疗组患者相比，部分有其他独立危险因素。在平均近4年的随访期间，基层医疗组的全因死亡率高于医院医疗组。与医院医疗组相比，在基层医疗管理的匹配心力衰竭患者中，肾素-血管紧张素系统拮抗剂、β受体阻滞剂以及两种药物的联合应用更少。
