Gerencia Atención Primaria de Barcelona, Institut Català de la Salut, Barcelona, Spain; Primary Health Care University Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain; School of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.
Primary Health Care University Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain; Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Sciences, University of Alicante, Spain; Hospital Universitari de Bellvitge, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain.
Aten Primaria. 2020 Aug-Sep;52(7):477-487. doi: 10.1016/j.aprim.2019.07.019. Epub 2020 Jan 10.
This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF).
Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain).
Patients with Advanced HF.
Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV.
The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months.
Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20kg/m (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69).
We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.
本研究旨在分析导致心力衰竭（HF）终末期患者短期和长期死亡率的主要因素的影响。
患者在属于加泰罗尼亚卫生研究所的 279 个初级保健中心之一就诊。
患有晚期 HF 的患者。
多中心队列研究，纳入了 1148 例 HF 患者，在达到纽约心脏协会（NYHA）IV 级后随访一年。
主要结局是全因死亡率。使用多变量逻辑回归模型评估 1、3、6 和 12 个月的结局。
患者的平均年龄为 82（9）岁，女性占 61.7%。分别有 135（11.8%）和 397（34.6%）名患者在纳入后 3 个月和 1 年时死亡。男性、年龄和体重指数降低与 3、6 和 12 个月时的死亡率升高相关。此外，低收缩压水平、肾小球滤过率严重降低、恶性肿瘤和更大剂量的袢利尿剂与 6 至 12 个月时的死亡率升高相关。整个时期最重要的危险因素是体重指数低于 20kg/m（3 个月的 OR 3.06，95%CI：1.58-5.92；6 个月的 OR 4.42，95%CI：2.08-9.38；12 个月的 OR 3.68，95%CI：1.76-7.69）。
我们可以得出结论，男性、年龄和体重指数降低决定了 NYHA IV 患者的短期死亡率较高。此外，低收缩压、肾小球滤过率降低、恶性肿瘤和更大剂量的袢利尿剂会增加中、长期死亡率的风险。这些变量易于测量，可以帮助决定如何应对疾病的最晚期。
