Inova Heart and Vascular Institute, Falls Church, Virginia; Duke University School of Medicine, Durham, North Carolina.
Duke University School of Medicine, Durham, North Carolina.
Am J Cardiol. 2019 Aug 15;124(4):545-553. doi: 10.1016/j.amjcard.2019.05.030. Epub 2019 May 25.
Congestion is associated with adverse outcomes in heart failure (HF) patients. We characterized congestion in patients hospitalized for HF and examined the association between congestion severity at admission and postdischarge outcomes. Using the OPTIMIZE-HF registry linked to Medicare claims, we analyzed patients ≥65 years old hospitalized for HF from 2003 to 2004. Congestion severity was measured using a 15-point scale that scores dyspnea, orthopnea, fatigue, jugular venous pressure, rales, and edema. Patient characteristics and outcomes were described by congestion strata. Proportional hazards models were fit to examine associations between congestion and 1-year outcomes. Congestion scores for the 24,724 patients ranged from 0 to 14, with a median of 5 (Q1, Q3: 3, 7). At baseline, patients with the highest scores (≥7) had the highest rates of recent HF hospitalizations, EF ≤40%, and co-morbidities, including arrhythmias, diabetes mellitus, and renal insufficiency. Adjusting for patient characteristics, a 3-point congestion score increase was positively associated with mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03, 1.09), all-cause rehospitalization (HR 1.02, 95% CI 1.00, 1.04), and HF rehospitalization (HR 1.09, 95% CI 1.06, 1.12), but not emergency department visits (HR 0.99, 95% CI 0.97, 1.01). In conclusion, for patients hospitalized with HF, congestion was associated with rehospitalization and mortality.
充血与心力衰竭（HF）患者的不良结局相关。我们描述了因 HF 住院的患者的充血情况，并检查了入院时充血严重程度与出院后结局之间的关系。我们利用 OPTIMIZE-HF 注册中心与医疗保险索赔数据进行关联分析，研究了 2003 年至 2004 年期间因 HF 住院的年龄≥65 岁的患者。充血严重程度使用 15 分制量表进行评估，该量表对呼吸困难、端坐呼吸、疲劳、颈静脉压、啰音和水肿进行评分。根据充血分层描述患者特征和结局。使用比例风险模型检查充血与 1 年结局之间的关联。24724 例患者的充血评分范围为 0 至 14 分，中位数为 5 分（Q1，Q3：3，7）。在基线时，得分最高（≥7）的患者最近 HF 住院率、EF≤40%和合并症（包括心律失常、糖尿病和肾功能不全）的发生率最高。在调整患者特征后，充血评分增加 3 分与死亡率（风险比 [HR] 1.06，95%置信区间 [CI] 1.03，1.09）、全因再住院率（HR 1.02，95% CI 1.00，1.04）和 HF 再住院率（HR 1.09，95% CI 1.06，1.12）呈正相关，但与急诊科就诊次数（HR 0.99，95% CI 0.97，1.01）无关。总之，对于因 HF 住院的患者，充血与再住院和死亡率相关。
