Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
JACC Heart Fail. 2018 Aug;6(8):678-685. doi: 10.1016/j.jchf.2018.03.006. Epub 2018 Jul 11.
This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community.
Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality.
In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were ≥60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades.
Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade.
In several U.S. community-based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations.
本研究旨在确定社区中心力衰竭（HF）及其亚型（射血分数降低性心力衰竭[HFrEF]和射血分数保留性心力衰竭[HFpEF]）的发病率和死亡率的时间趋势。
心血管疾病危险因素流行率的重大变化和治疗方法的进步可能影响 HF 的发病率和死亡率。
在 FHS（弗雷明汉心脏研究）和 CHS（心血管健康研究）中，对于≥60 岁且无 HF 的参与者（n=15217；女性占 60%；2524 例新发 HF 病例；115703 人年随访），我们从 1990 年至 1999 年和 2000 年至 2009 年估计了 HF、HFrEF 和 HFpEF 的调整发病率比值。我们比较了两个十年内和两个十年之间 HFrEF 与 HFpEF 相关的累积发病率和死亡率。
在这 20 年中，HF 的发病率比值相似（p=0.13）。HFrEF 的发病率比值下降（p=0.0029），而 HFpEF 增加（p<0.001）。尽管 HFrEF 的发病率在男性中下降幅度大于女性，但在每个十年中，男性的 HFrEF 发病率均高于女性（p<0.001）。HFpEF 的发病率在男性和女性中均随时间显著增加（p<0.001 和 p=0.02，分别）。在 HF 后随访期间，有 1701 人死亡（67.4%；HFrEF，n=557[33%]；HFpEF，n=474[29%]）。在 HF 亚型内或在十年内 HFrEF 和 HFpEF 之间，各十年之间 HF 亚型或 HFrEF 和 HFpEF 之间的死亡率（总体、心血管疾病和非心血管疾病）均无显著差异。
在 1990 年至 2009 年期间，我们在美国几个社区样本中观察到 HFrEF 发病率下降和 HFpEF 发病率上升的趋势不同，整体 HF 发病率稳定且死亡率高。我们的研究结果强调了需要阐明导致这些观察结果的因素。
