Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
Eur J Heart Fail. 2019 Nov;21(11):1306-1325. doi: 10.1002/ejhf.1594. Epub 2019 Sep 16.
To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting.
We searched in relevant databases from inception to August 2018 for non-interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta-analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3-96.9), 86.5% (85.4-87.6), 72.6% (67.0-76.6), 56.7% (54.0-59.4) and 34.9% (24.0-46.8), respectively. The 5-year survival rates improved between 1970-1979 and 2000-2009 across healthcare settings, from 29.1% (25.5-32.7) to 59.7% (54.7-64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co-morbidities, and treatment rates.
These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence-based treatments. Further research exploring the barriers and facilitators to treatment is recommended.
为慢性心力衰竭患者提供可靠的生存估计，并通过关键因素（包括诊断时的年龄、左心室射血分数、诊断的十年以及研究环境）解释生存差异。
我们从研究开始到 2018 年 8 月，在相关数据库中搜索了在任何门诊环境下报告慢性或稳定心力衰竭患者生存率的非干预性研究。在 60 项纳入的研究中，有 150 万心力衰竭患者的生存数据。在我们的随机效应荟萃分析中，1 个月、1 年、2 年、5 年和 10 年的合并生存率分别为 95.7%（95%置信区间 94.3-96.9）、86.5%（85.4-87.6）、72.6%（67.0-76.6）、56.7%（54.0-59.4）和 34.9%（24.0-46.8）。在整个医疗保健环境中，1970-1979 年至 2000-2009 年期间，5 年生存率有所提高，从 29.1%（25.5-32.7）提高到 59.7%（54.7-64.6）。诊断时年龄的增加与生存时间的缩短显著相关。在二级保健中进行的研究中死亡率最低，这些研究报告了关键心力衰竭药物的更高处方率。纳入研究在心力衰竭诊断标准、参与者合并症和治疗率方面存在显著异质性。
这些结果可以为卫生政策和个体患者的高级护理计划提供信息。尽管慢性心力衰竭的生存率稳步提高，但死亡率仍然很高。通过更广泛地实施基于证据的治疗方法，仍有很大的改善预后的空间。建议进一步研究探索治疗的障碍和促进因素。
