Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Cardiovascular Department, University of Trieste, Italy.
Eur J Heart Fail. 2018 Sep;20(9):1257-1266. doi: 10.1002/ejhf.1202. Epub 2018 Jun 19.
To assess adverse outcomes attributable to non-cardiac co-morbidities and to compare their effects by left ventricular ejection fraction (LVEF) group [LVEF <50% (heart failure with reduced ejection fraction, HFrEF), LVEF ≥50% (heart failure with preserved ejection fraction, HFpEF)] in a contemporary, unselected chronic heart failure population.
This community-based cohort enrolled patients from October 2009 to December 2013. Adjusted hazard ratio (HR) and the population attributable fraction (PAF) were used to compare the contribution of 15 non-cardiac co-morbidities to adverse outcome. Overall, 2314 patients (mean age 77 ±10 years, 57% men) were recruited [n = 941 (41%) HFrEF, n = 1373 (59%) HFpEF]. Non-cardiac co-morbidity rates were similarly high, except for obesity and hypertension which were more prevalent in HFpEF. At a median follow-up of 31 (interquartile range 16-41) months, 472 (20%) patients died. Adjusted mortality rates were not significantly different between the HFrEF and HFpEF groups. After adjustment, an increasing number of non-cardiac co-morbidities was associated with a higher risk for all-cause mortality [HR 1.25; 95% confidence interval (CI) 1.10-1.26; P < 0.001], all-cause hospitalization (HR 1.17; 95% CI 1.12-1.23; P < 0.001), heart failure hospitalization (HR 1.28; 95% CI 1.19-1.38; P < 0.001), non-cardiovascular hospitalization (HR 1.16; 95% CI 1.11-1.22; P < 0.001). The co-morbidities contributing to high PAF were: anaemia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and peripheral artery disease. These findings were similar for HFrEF and HFpEF. Interaction analysis yielded similar results.
In a contemporary community population with chronic heart failure, non-cardiac co-morbidities confer a similar contribution to outcomes in HFrEF and HFpEF. These observations suggest that quality improvement initiatives aimed at optimizing co-morbidities may be similarly effective in HFrEF and HFpEF.
评估非心脏合并症导致的不良结局，并比较其在左心室射血分数（LVEF）组[LVEF<50%（射血分数降低的心力衰竭，HFrEF），LVEF≥50%（射血分数保留的心力衰竭，HFpEF）]中的作用。在当代未经选择的慢性心力衰竭人群中。
这项基于社区的队列研究纳入了 2009 年 10 月至 2013 年 12 月期间的患者。使用调整后的风险比（HR）和人群归因分数（PAF）来比较 15 种非心脏合并症对不良结局的贡献。总体而言，共招募了 2314 名患者（平均年龄 77±10 岁，57%为男性）[n=941（41%）HFrEF，n=1373（59%）HFpEF]。除肥胖症和高血压在 HFpEF 中更为常见外，非心脏合并症的发生率也同样较高。中位随访 31 个月（四分位距 16-41），472 名（20%）患者死亡。HFrEF 和 HFpEF 组之间的调整死亡率没有显著差异。调整后，非心脏合并症的数量与全因死亡率[HR 1.25；95%置信区间（CI）1.10-1.26；P<0.001]、全因住院率[HR 1.17；95%CI 1.12-1.23；P<0.001]、心力衰竭住院率[HR 1.28；95%CI 1.19-1.38；P<0.001]、非心血管住院率[HR 1.16；95%CI 1.11-1.22；P<0.001]的风险增加呈正相关。导致高 PAF 的合并症有：贫血、慢性肾脏病、慢性阻塞性肺疾病、糖尿病和外周动脉疾病。这些发现在 HFrEF 和 HFpEF 中相似。交互分析得出了相似的结果。
在当代患有慢性心力衰竭的社区人群中，非心脏合并症对 HFrEF 和 HFpEF 的结局有相似的影响。这些观察结果表明，旨在优化合并症的质量改进举措在 HFrEF 和 HFpEF 中可能同样有效。
