Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
Peter Munk Cardiac Centre, Toronto General Hospital and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
JAMA Cardiol. 2019 Apr 1;4(4):363-369. doi: 10.1001/jamacardio.2019.0549.
Influenza is associated with an increased risk of cardiovascular events, but to our knowledge, few studies have explored the temporal association between influenza activity and hospitalizations, especially those caused by heart failure (HF).
To explore the temporal association between influenza activity and hospitalizations due to HF and myocardial infarction (MI). We hypothesized that increased influenza activity would be associated with an increase in hospitalizations for HF and MI among adults in the community.
DESIGN, SETTING, AND PARTICIPANTS: As part of the community surveillance component of the Atherosclerosis Risk in Communities (ARIC) study, a population-based study with hospitalizations sampled from 4 US communities, data were collected from 451 588 adults aged 35 to 84 years residing in the ARIC communities from annual cross-sectional stratified random samples of hospitalizations during October 2010 to September 2014.
Monthly influenza activity, defined as the percentage of patient visits to sentinel clinicians for influenza-like illness by state, as reported by the Centers for Disease Control and Prevention Surveillance Network.
The monthly frequency of MI hospitalizations (n = 3541) and HF hospitalizations (n = 4321), collected through community surveillance and adjudicated as part of the ARIC Study.
Between October 2010 and September 2014, 2042 (47.3%) and 1599 (45.1%) of the sampled patients who were hospitalized for HF and MI, respectively, were women and 2391 (53.3%) and 2013 (57.4%) were white, respectively. A 5% monthly absolute increase in influenza activity was associated with a 24% increase in HF hospitalization rates, standardized to the total population in each community, within the same month after adjusting for region, season, race/ethnicity, sex, age, and number of MI/HF hospitalizations from the month before (incidence rate ratio, 1.24; 95% CI, 1.11-1.38; P < .001), while overall influenza activity was not significantly associated with MI hospitalizations (incidence rate ratio, 1.02; 95% CI, 0.90-1.17; P = .72). Influenza activity in the months before hospitalization was not associated with either outcome. Our model suggests that in a month with high influenza activity, approximately 19% of HF hospitalizations (95% CI, 10%-28%) could be attributable to influenza.
Influenza activity was temporally associated with an increase in HF hospitalizations across 4 influenza seasons. These data suggest that influenza may contribute to the risk of HF hospitalization in the general population.
流感与心血管事件风险增加有关，但据我们所知，很少有研究探讨流感活动与住院之间的时间关联，特别是与心力衰竭（HF）相关的住院。
探讨流感活动与心力衰竭和心肌梗死（MI）住院之间的时间关联。我们假设，社区内成年人的流感活动增加与 HF 和 MI 的住院人数增加有关。
设计、地点和参与者：作为 Atherosclerosis Risk in Communities（ARIC）研究社区监测部分的一部分，该研究是一项基于人群的研究，对来自美国 4 个社区的住院患者进行抽样，数据来自于 2010 年 10 月至 2014 年 9 月期间每年通过社区监测收集的 451,588 名年龄在 35 至 84 岁之间的成年人的住院分层随机样本。
每月流感活动，定义为按州报告的流感样疾病患者就诊百分比，由疾病控制与预防中心监测网络报告。
MI 住院（n=3541）和 HF 住院（n=4321）的每月频率，通过社区监测收集，并作为 ARIC 研究的一部分进行裁决。
在 2010 年 10 月至 2014 年 9 月期间，分别有 2042（47.3%）和 1599（45.1%）名因 HF 和 MI 住院的患者为女性，分别有 2391（53.3%）和 2013（57.4%）名患者为白人。在同一月份内，在调整了每个社区的地区、季节、种族/民族、性别、年龄以及前一个月的 MI/HF 住院次数后，流感活动每月绝对增加 5%，与 HF 住院率增加 24%相关，标准化到每个社区的总人口（发病率比，1.24；95%置信区间，1.11-1.38；P<0.001），而总体流感活动与 MI 住院无显著相关性（发病率比，1.02；95%置信区间，0.90-1.17；P=0.72）。住院前几个月的流感活动与这两个结果均无关。我们的模型表明，在流感活动较高的月份，HF 住院的约 19%（95%置信区间，10%-28%）可能归因于流感。
流感活动与 4 个流感季节的 HF 住院增加呈时间相关。这些数据表明，流感可能导致普通人群 HF 住院的风险增加。
