Duke Clinical Research Institute, Duke University, Durham, NC (A.S., X.Z., B.G.H., A.F.H., G.M.F., A.D.D.).
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (A.S., J.A.E.).
Circ Heart Fail. 2018 Jun;11(6):e004646. doi: 10.1161/CIRCHEARTFAILURE.117.004646.
The increase in medical complexity among patients hospitalized with heart failure (HF) may be reflected by an increase in concomitant noncardiovascular comorbidities. Among patients hospitalized with HF, the temporal trends in the prevalence of noncardiovascular comorbidities have not been well described.
We used data from 207 984 patients in the Get With The Guidelines-Heart Failure registry (from 2005 to 2014) to evaluate the prevalence and trends of noncardiovascular comorbidities (chronic obstructive pulmonary disorder/asthma, anemia, diabetes mellitus, obesity [body mass index ≥30 kg/m], and renal impairment) among patients hospitalized with HF. Medicare beneficiaries aged ≥65 years were used to assess 30-day mortality. The prevalence of 0, 1, 2, and ≥3 noncardiovascular comorbidities was 18%, 30%, 27%, 25%, respectively. From 2005 to 2014, there was a decline in patients with 0 noncardiovascular comorbidities (22%-16%; <0.0001) and an increase in patients with ≥3 noncardiovascular comorbidities (18%-29%; <0.0001). Among Medicare beneficiaries, there was an increased 30-day adjusted mortality risk among patients with 1 noncardiovascular comorbidity (hazard ratio, 1.16; 95% confidence interval, 1.09-1.24; <0.0001), 2 noncardiovascular comorbidities (hazard ratio, 1.34; 95% confidence interval, 1.25-1.44; <0.0001), and ≥3 noncardiovascular comorbidities (hazard ratio, 1.63; 95% confidence interval, 1.51-1.75; <0.0001). Similar trends were seen for in-hospital mortality.
Patients admitted in hospital for HF have an increasing number of noncardiovascular comorbidities over time, which are associated with worse outcomes. Strategies addressing the growing burden of noncardiovascular comorbidities may represent an avenue to improve outcomes and should be included in the delivery of in-hospital HF care.
住院心力衰竭（HF）患者的医疗复杂性增加可能反映在并发非心血管合并症的增加。在住院 HF 患者中，非心血管合并症的流行趋势尚未得到很好的描述。
我们使用来自 2005 年至 2014 年的 Get With The Guidelines-Heart Failure 登记处的 207984 名患者的数据，评估住院 HF 患者中非心血管合并症（慢性阻塞性肺疾病/哮喘、贫血、糖尿病、肥胖症[体重指数≥30kg/m]和肾功能损害）的患病率和趋势。使用医疗保险受益人为年龄≥65 岁的患者评估 30 天死亡率。0、1、2 和≥3 种非心血管合并症的患病率分别为 18%、30%、27%和 25%。从 2005 年到 2014 年，无非心血管合并症的患者比例从 22%下降到 16%（<0.0001），而有≥3 种非心血管合并症的患者比例从 18%增加到 29%（<0.0001）。在医疗保险受益人群中，有 1 种非心血管合并症的患者的 30 天调整死亡率风险增加（风险比，1.16；95%置信区间，1.09-1.24；<0.0001），2 种非心血管合并症的患者（风险比，1.34；95%置信区间，1.25-1.44；<0.0001），以及≥3 种非心血管合并症的患者（风险比，1.63；95%置信区间，1.51-1.75；<0.0001）。住院死亡率也存在类似的趋势。
随着时间的推移，因 HF 住院的患者的非心血管合并症数量不断增加，这与预后更差有关。解决非心血管合并症负担日益增加的策略可能是改善预后的途径，应纳入住院 HF 治疗。
