1 College of Nursing, University of South Florida, USA.
2 College of Nursing, University of Kentucky, USA.
Eur J Cardiovasc Nurs. 2019 Mar;18(3):245-252. doi: 10.1177/1474515118822373. Epub 2019 Jan 4.
Comorbid chronic obstructive pulmonary disease is found in approximately one-third of patients with heart failure. Survival in patients with chronic obstructive pulmonary disease generally decreases as lung function declines. However, the association between lung function, hospitalization and survival is less clear for patients with heart failure.
The purpose of this study was to determine the predictive power of spirometry measures for event-free survival (combined all-cause hospitalization and/or mortality) in patients with heart failure.
In this secondary analysis of data from three prospective, longitudinal studies, we selected patients with a confirmed diagnosis of heart failure who completed airflow limitation assessment using spirometry measures ( n=137): forced vital capacity, forced expiratory volume/second, and forced expiratory volume/second/forced vital capacity. Cox proportional hazards modeling was used to determine the relationship between spirometry and all-cause hospitalization/mortality with and without adjusting for demographic and clinical covariates over a four-year follow-up period.
A majority (74%) exhibited some degree of airflow limitation (forced expiratory volume/second<80% predicted value) and 26 (19%) met the spirometric criterion for chronic obstructive pulmonary disease (forced expiratory volume/second/forced vital capacity⩽0.70). Cox proportional hazards regression models compared all-cause hospitalization/mortality between those with and without airflow limitation. Patients with airflow limitation were 2.2 times more likely to be hospitalized or die compared to those without airflow limitations (hazard ratio: 2.20, 95% confidence interval 1.06-4.53, p=0.03).
Patients with comorbid heart failure and airflow limitation were at more than double the risk for an event. Spirometric measures may be useful to patients with heart failure, as tailored management of airflow limitation may impact event-free survival.
约三分之一的心衰患者合并患有慢性阻塞性肺疾病。慢性阻塞性肺疾病患者的生存率一般随着肺功能下降而降低。然而，对于心力衰竭患者，肺功能、住院和生存率之间的关系则不太明确。
本研究旨在确定肺功能测量对心力衰竭患者无事件生存（包括全因住院和/或死亡）的预测能力。
本研究对三项前瞻性、纵向研究的数据进行了二次分析，入选了完成了肺通气功能评估（n=137）的确诊心力衰竭患者：用力肺活量、一秒用力呼气量、一秒用力呼气量/用力肺活量。使用 Cox 比例风险模型，确定了在四年随访期间，不调整人口统计学和临床协变量的情况下，肺功能与全因住院/死亡率之间的关系。
大多数患者（74%）存在一定程度的气流受限（一秒用力呼气量<80%预计值），26 名患者（19%）符合慢性阻塞性肺疾病的肺通气功能标准（一秒用力呼气量/用力肺活量⩽0.70）。Cox 比例风险回归模型比较了有和无气流受限患者的全因住院/死亡率。与无气流受限患者相比，有气流受限患者住院或死亡的风险增加了 2.2 倍（危险比：2.20，95%置信区间 1.06-4.53，p=0.03）。
合并有心力衰竭和气流受限的患者发生事件的风险增加了两倍以上。肺功能测量可能对心力衰竭患者有用，因为对气流受限的个体化管理可能会影响无事件生存。
