Cleveland Clinic Foundation, Cleveland, Ohio.
University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, Connecticut; School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.
Am J Cardiol. 2019 Sep 15;124(6):926-931. doi: 10.1016/j.amjcard.2019.05.070. Epub 2019 Jun 24.
Concomitant heart failure (HF) and mitral valve disease (MVD) portend significant morbidity and mortality. Although associated Tricuspid regurgitation (TR) is a common occurrence in this scenario, it is not well known whether there are additional prognostic implications. We sought to assess whether coexistent TR is associated with higher readmission rates or increased mortality in patients with HF and MVD. We identified 1,520,871 encounters with a primary diagnosis of HF in the 2013 to 2014 Nationwide Readmission Database. We excluded patients without MVD, patients <18 years old, those with rheumatic heart disease and infective endocarditis. We also excluded patients who were discharged in December, hospital transfers, and cases where follow-up or outcomes were missing. Logistic regression was used to evaluate the association between baseline characteristics (including the presence of tricuspid valve disease), mortality as well as 30-day readmission rates. A total of 221,127 admissions with HF and MVD were identified. Median age was 79 years (IQR, 67 to 87), 55% were female, 2.7% died during hospitalization, and the 30-day readmission rate was 20.3%. Nearly 1/3 had concomitant TR (n = 78,356, 35%). The presence of TR was neither associated with elevated risk of mortality (hazard ratio 0.98, 95% confidence interval 0.93 to 1.04) nor 30-day readmission rate (odds ratio 1.01, 95% confidence interval 0.98 to 1.03). HF accounted for 33% of 30-day readmissions, while combined cardiac causes accounted for 54%. In conclusion concomitant TR in patients with HF and MVD was not associated with worse short-term outcomes in terms of inpatient hospital mortality and 30-day readmission rates.
同时患有心力衰竭（HF）和二尖瓣疾病（MVD）预示着较高的发病率和死亡率。虽然在此情况下常伴有三尖瓣反流（TR），但尚不清楚是否存在其他预后影响。我们旨在评估 HF 和 MVD 患者中同时存在的 TR 是否与更高的再入院率或死亡率相关。我们在 2013 年至 2014 年全国再入院数据库中确定了 1520871 例原发性 HF 就诊。我们排除了无 MVD、年龄<18 岁、风湿性心脏病和感染性心内膜炎的患者。我们还排除了在 12 月出院、医院转院以及随访或结果缺失的患者。使用逻辑回归评估基线特征（包括三尖瓣疾病的存在）、死亡率以及 30 天再入院率之间的相关性。共确定了 221127 例 HF 和 MVD 住院患者。中位年龄为 79 岁（IQR，67 至 87），55%为女性，2.7%在住院期间死亡，30 天再入院率为 20.3%。近 1/3 同时伴有 TR（n=78356，35%）。TR 的存在既不与死亡率升高相关（危险比 0.98，95%置信区间 0.93 至 1.04），也不与 30 天再入院率相关（比值比 1.01，95%置信区间 0.98 至 1.03）。HF 占 30 天再入院的 33%，而联合心脏原因占 54%。总之，HF 和 MVD 患者同时伴有 TR 与住院期间死亡率和 30 天再入院率等短期预后无显著相关性。
