心力衰竭及其他合并症对慢性阻塞性肺疾病患者死亡率的影响：一项基于登记的前瞻性队列研究。
Impact of heart failure and other comorbidities on mortality in patients with chronic obstructive pulmonary disease: a register-based, prospective cohort study.
作者信息
Kaszuba Elzbieta, Odeberg Håkan, Råstam Lennart, Halling Anders
机构信息
Samaritens Primary Health Care Centre, 374 80, Karlshamn, Sweden.
Department of Clinical Sciences in Malmö General Practice, Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.
出版信息
BMC Fam Pract. 2018 Nov 24;19(1):178. doi: 10.1186/s12875-018-0865-8.
BACKGROUND
Multimorbidity has already become common in primary care and will be a challenge in the future. Primary care in Sweden participates to a great extent in the care of patients with two severe, chronic conditions: chronic obstructive pulmonary disease (COPD) and heart failure. Both conditions are characterized by high mortality and often coexist. Age, sex, heart failure and other comorbidities are considered to be the major predictors of mortality in patients with COPD. We aimed to study the impact of heart failure, other comorbidities, age and sex on mortality in patients with COPD.
METHODS
A register-based, prospective cohort study conducted in Blekinge County in Sweden with about 150,000 inhabitants. The study population was comprised of people aged ≥35 years. The data about diagnoses of COPD and heart failure came from the 2007 health care register, in which we found 984 individuals with a diagnosis of COPD. Date of death was collected from January 1st, 2008 -August 31st, 2015. The diagnosis-based Adjusted Clinical Groups (ACG) Case-Mix System 7.1 was used to describe comorbidity. Each individual was assigned one of six comorbidity levels called resource utilization bands (RUB) graded from 0 to 5.
RESULTS
Estimated eight year mortality in patients with COPD and coexisting heart failure was seven times higher than in patients with COPD alone - odds ratio 7.06 (95% CI 3.88-12.84). Adjusting for age and male sex resulted in odds ratio 3.75 (95% CI 1.97-7.15). Further adjusting for other comorbidities resulted in odds ratio 3.26 (95% CI 1.70-6.25). The mortality was strongly associated with the highest comorbidity level - RUB 5 where the odds ratio was 5.19 (95% CI 2.59-10.38).
CONCLUSION
Heart failure has an important impact on mortality in patients with COPD. The mortality in patients with COPD and coexisting heart failure was strongly associated with age, male sex and other comorbidities. Of those three predictors, only other comorbidities can be influenced. Heart failure and other comorbidities should be recognized early and properly treated in order to improve survival in patients with coexisting COPD and heart failure.
背景
多病共存已在基层医疗中普遍存在，且在未来将成为一项挑战。瑞典的基层医疗在很大程度上参与了患有两种严重慢性病（慢性阻塞性肺疾病（COPD）和心力衰竭）患者的护理工作。这两种疾病都具有高死亡率的特点，且常常同时存在。年龄、性别、心力衰竭及其他合并症被认为是慢性阻塞性肺疾病患者死亡率的主要预测因素。我们旨在研究心力衰竭、其他合并症、年龄和性别对慢性阻塞性肺疾病患者死亡率的影响。
方法
在瑞典布莱金厄省进行了一项基于登记的前瞻性队列研究，该省约有15万居民。研究人群包括年龄≥35岁的人群。慢性阻塞性肺疾病和心力衰竭的诊断数据来自2007年的医疗保健登记册，我们从中发现了984例诊断为慢性阻塞性肺疾病的患者。收集了2008年1月1日至2015年8月31日的死亡日期。基于诊断的调整临床分组（ACG）病例组合系统7.1用于描述合并症情况。每个个体被分配到六个合并症水平之一，称为资源利用带（RUB），从0到5分级。
结果
患有慢性阻塞性肺疾病且同时患有心力衰竭的患者估计八年死亡率比仅患有慢性阻塞性肺疾病的患者高七倍——比值比为7.06（95%置信区间3.88 - 12.84）。对年龄和男性性别进行调整后，比值比为3.75（95%置信区间1.97 - 7.15）。进一步对其他合并症进行调整后，比值比为3.26（95%置信区间1.70 - 6.25）。死亡率与最高合并症水平——RUB 5密切相关，其比值比为5.19（95%置信区间2.59 - 10.38）。
结论
心力衰竭对慢性阻塞性肺疾病患者的死亡率有重要影响。患有慢性阻塞性肺疾病且同时患有心力衰竭的患者的死亡率与年龄、男性性别和其他合并症密切相关。在这三个预测因素中，只有其他合并症可以受到影响。应尽早识别并妥善治疗心力衰竭和其他合并症，以提高同时患有慢性阻塞性肺疾病和心力衰竭患者的生存率。
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