Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Badalona, Spain.
Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
Eur J Heart Fail. 2019 Oct;21(10):1259-1266. doi: 10.1002/ejhf.1569. Epub 2019 Jul 30.
Better management of heart failure (HF) over the past two decades has improved survival, mainly by reducing the incidence of death due to cardiovascular (CV) causes. Deaths due to non-CV causes, particularly cancer, may be increasing. This study explored the modes of death of consecutive patients who attended a HF clinic over 17 years.
A total of 935 deaths were ascertained from 2002 to 2018 among 1876 patients (mean age 65.8 ± 12.5 years, 75% men, left ventricular ejection fraction < 50%) admitted to our HF clinic. Median follow-up was 4.2 years [1.9-7.8]. Mode of death was curated from patient health records and verified by the Catalan and Spanish health system databases. Trends for every mode of death were assessed by polynomial regression. Two trends were observed: a significant reduction in sudden death (P = 0.03) without changes in HF progression as mode of death (P = 0.26), and a significant increase in non-CV modes of death (P < 0.001). Non-CV deaths accounted for 17.4% of deaths in 2002 and 65.8% of deaths in 2018. A total 138 deaths were due to cancer (37% of non-CV deaths). A significant trend was observed towards a progressive increase in cancer deaths over time (P = 0.002). The main mode of cancer mortality was lung cancer.
The modes of death in HF have shifted over the last two decades. Patients with HF die less due to sudden death and more due to non-CV causes, mainly cancer. Whether HF triggers cancer, or cancer develops in HF survivors, deserves further insight.
过去二十年来，心力衰竭（HF）管理水平的提高改善了患者的生存率，主要是通过降低心血管（CV）原因导致的死亡率。而非 CV 原因（尤其是癌症）导致的死亡可能在增加。本研究旨在探讨在 17 年时间里连续就诊于 HF 门诊的患者的死亡模式。
共从 2002 年至 2018 年期间在我们 HF 门诊就诊的 1876 例患者（平均年龄 65.8±12.5 岁，75%为男性，左心室射血分数<50%）中确定了 935 例死亡病例。中位随访时间为 4.2 年（1.9-7.8）。死亡模式是从患者的健康记录中提取出来的，并通过加泰罗尼亚和西班牙卫生系统数据库进行了验证。通过多项式回归评估了每种死亡模式的趋势。观察到两种趋势：猝死明显减少（P=0.03），但心力衰竭进展作为死亡模式没有变化（P=0.26），而非 CV 死亡模式显著增加（P<0.001）。非 CV 死亡在 2002 年占死亡人数的 17.4%，而在 2018 年占 65.8%。共有 138 例死亡归因于癌症（非 CV 死亡的 37%）。随着时间的推移，癌症死亡人数呈显著增加趋势（P=0.002）。癌症死亡的主要模式是肺癌。
在过去的二十年中，HF 的死亡模式发生了变化。HF 患者死于猝死的比例降低，死于非 CV 原因（主要是癌症）的比例增加。HF 是否会引发癌症，或者癌症是否在 HF 幸存者中发展，这值得进一步深入研究。
