老年心力衰竭患者的事件性贫血：发生率、病因学及与结局的关系。
Incident anaemia in older adults with heart failure: rate, aetiology, and association with outcomes.
机构信息
Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA.
出版信息
Eur Heart J Qual Care Clin Outcomes. 2019 Oct 1;5(4):361-369. doi: 10.1093/ehjqcco/qcz010.
AIMS
Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anaemia of the elderly in heart failure (HF). Thus, we aimed to determine the incidence of anaemia, to characterize diagnostic testing patterns for potentially reversible causes of anaemia, and to evaluate the independent association between incident anaemia and long-term morbidity and mortality.
METHODS AND RESULTS
Within the Cardiovascular Research Network (CVRN), we identified adults age ≥65 years with diagnosed HF between 2005 and 2012 and no anaemia at entry. Incident anaemia was defined using World Health Organization (WHO) haemoglobin thresholds (<13.0 g/dL in men; <12.0 g/dL in women). All-cause death and hospitalizations for HF and any cause were identified from electronic health records. Among 38 826 older HF patients, 22 163 (57.1%) developed incident anaemia over a median (interquartile range) follow-up of 2.9 (1.2-5.6) years. The crude rate [95% confidence interval (CI)] per 100 person-years of incident anaemia was 26.4 (95% CI 26.0-26.7) and was higher for preserved ejection fraction (EF) [29.2 (95% CI 28.6-29.8)] compared with borderline EF [26.5 (95% CI 25.4-27.7)] or reduced EF [26.6 (95% CI 25.8-27.4)]. Iron indices, vitamin B12 level, and thyroid testing were performed in 20.9%, 14.9%, and 40.2% of patients, respectively. Reduced iron stores, vitamin B12 deficiency, and/or hypothyroidism were present in 29.7%, 3.2%, and 18.6% of tested patients, respectively. In multivariable analyses, incident anaemia was associated with excess mortality [hazard ratio (HR) 2.14, 95% CI 2.07-2.22] as well as hospitalization for HF (HR 1.80, 95% CI 1.72-1.88) and any cause (HR 1.77, 95% CI 1.72-1.83).
CONCLUSION
Among older adults with HF, incident anaemia is common and independently associated with substantially increased risks of morbidity and mortality. Additional research is necessary to clarify the value of routine evaluation and treatment of potentially reversible causes of anaemia.
目的
老年人心力衰竭（HF）中不明原因贫血的流行病学、评估和预后的数据有限。因此，我们旨在确定贫血的发生率，描述潜在可纠正贫血病因的诊断检测模式，并评估新发贫血与长期发病率和死亡率的独立相关性。
方法和结果
在心血管研究网络（CVRN）中，我们确定了 2005 年至 2012 年间诊断为 HF 且入组时无贫血的年龄≥65 岁的成年人。新发贫血采用世界卫生组织（WHO）血红蛋白阈值（男性<13.0 g/dL；女性<12.0 g/dL）定义。全因死亡和 HF 及任何原因住院均从电子健康记录中确定。在 38826 名老年 HF 患者中，中位（四分位距）2.9（1.2-5.6）年随访期间，22163 名（57.1%）发生了新发贫血。每 100 人年的发生率[95%置信区间（CI）]为 26.4（95% CI 26.0-26.7），射血分数保留（EF）[29.2（95% CI 28.6-29.8）]高于 EF 边界[26.5（95% CI 25.4-27.7）]或 EF 降低[26.6（95% CI 25.8-27.4）]。分别有 20.9%、14.9%和 40.2%的患者进行了铁指标、维生素 B12 水平和甲状腺检查。在接受检测的患者中，分别有 29.7%、3.2%和 18.6%存在铁储存减少、维生素 B12 缺乏和/或甲状腺功能减退。多变量分析显示，新发贫血与死亡率增加相关[风险比（HR）2.14，95% CI 2.07-2.22]，HF 住院[HR 1.80，95% CI 1.72-1.88]和任何原因住院[HR 1.77，95% CI 1.72-1.83]。
结论
在老年 HF 患者中，新发贫血很常见，与发病率和死亡率的显著增加独立相关。需要进一步研究以明确常规评估和治疗潜在可纠正贫血病因的价值。
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