Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
Sci Rep. 2018 Sep 24;8(1):14270. doi: 10.1038/s41598-018-32684-9.
The prognostic factors and pharmacological effects of the very elderly patients (aged ≥80 years) with acute heart failure (AHF) remain unclear. The study, therefore, investigated the prognostic impacts of the guideline-recommended pharmacological therapy in these patients. A cohort of 1297 very elderly patients [85.1 ± 4.0 years, 69.7% male, 32.6% heart failure with reduced left ventricular ejection fraction (LVEF), HFrEF], hospitalized for AHF, was studied. The percentage of the recommended prescription for HFrEF at discharge, including renin-angiotensin system inhibitors, β-blockers, and mineralocorticoid receptor antagonists, was calculated as guideline adherence indicator (GAI). Among the 1233 survivors at discharge, 495 subjects (40.1%) died during a mean follow-up of 27.1 ± 23.9 months. Mean GAIs in HFrEF and HFpEF were 70.6 ± 34.9% and 64.1 ± 35.9%, respectively. A higher GAI was associated with less overall mortality [hazard ratio and 95% confidence interval per-1SD: 0.781, 0.655-0.930] and cardiovascular death (0.718, 0.558-0.925), independent of age, gender, diabetes, hypertension, mean blood pressure, LVEF, eGFR, sodium, and NT-proBNP. A GAI of 100% was associated with a better survival in both HFrEF and HFpEF. A prescription of the three recommended medications for HFrEF to the very elderly AHF patients was associated with a better survival after discharge.
高龄（≥80 岁）急性心力衰竭（AHF）患者的预后因素和药理学效应仍不清楚。因此，本研究调查了指南推荐的药物治疗对这些患者的预后影响。研究纳入了 1297 例高龄（85.1±4.0 岁，69.7%为男性，32.6%为射血分数降低的心力衰竭，HFrEF）AHF 住院患者。出院时根据指南推荐处方计算出 HFrEF 推荐药物的使用比例（包括肾素-血管紧张素系统抑制剂、β受体阻滞剂和盐皮质激素受体拮抗剂）作为指南依从性指标（GAI）。在出院的 1233 例存活患者中，495 例（40.1%）在平均 27.1±23.9 个月的随访期间死亡。HFrEF 和 HFpEF 的平均 GAI 分别为 70.6±34.9%和 64.1±35.9%。较高的 GAI 与全因死亡率降低相关[每增加 1 个标准差的风险比和 95%置信区间：0.781，0.655-0.930]和心血管死亡率降低（0.718，0.558-0.925），与年龄、性别、糖尿病、高血压、平均血压、LVEF、eGFR、钠和 NT-proBNP 无关。GAI 为 100%时，在 HFrEF 和 HFpEF 中均与更好的生存相关。对于高龄 AHF 患者，HFrEF 三种推荐药物的处方与出院后更好的生存相关。
