心力衰竭前合并症及其对心力衰竭患者预后的影响：一项全国性研究。

Preheart failure comorbidities and impact on prognosis in heart failure patients: a nationwide study.

机构信息

From the, Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark.

出版信息

J Intern Med. 2020 Jun;287(6):698-710. doi: 10.1111/joim.13033. Epub 2020 Feb 26.

DOI:10.1111/joim.13033

PMID:32103571

Abstract

BACKGROUND

Data regarding the impact of preheart failure (HF) comorbidities on the prognosis of HF are scarce, especially in the younger HF patients.

OBJECTIVES

To investigate pre-existing comorbidities in HF patients versus matched controls and to assess their impact on mortality.

METHODS

We included all first-time in-hospital and outpatient diagnoses of HF from 1995 to 2017, and comorbidities antedating the HF-diagnosis in the Danish nationwide registries. HF patients were matched with up to five controls. One-year all-cause mortality rates and population attributable risk (PAR) were estimated for three separate age groups (≤50, 51-74 and >74 years).

RESULTS

Totally 280 002 patients with HF and 1 166 773 controls were included. Cardiovascular comorbidities, for example, cerebrovascular disease and ischaemic heart disease were more frequent in the oldest (17.9% and 29.7% in HF vs. 9.8% and 10.7% in controls) compared to the youngest age group (3.9% and 15.2% in HF vs. 0.7% and 0.9% in controls). Amongst patients with HF, 1-year mortality rates (per 100 person-years) were highest amongst those with >1 noncardiovascular comorbidity: ≤50 years (10.4; 9.64-11.3), 51-74 years (23.3; 22.9-23.7), >74 years (58.5; 57.9-59.0); hazard ratios 245.18 (141.45-424.76), 45.85 (42.77-49.15) and 24.5 (23.64-25.68) for those ≤50, 51-74 and >74 years, respectively. For HF patients ≤50 years, PAR was greatest for hypertension (17.8%), cancer (14.1%) and alcohol abuse (8.5%). For those aged >74 years, PAR was greatest for hypertension (23.6%), cerebrovascular disease (6.2%) and cancer (7.2%).

CONCLUSIONS

Heart failure patients had a higher burden of pre-existing comorbidities, compared to controls, which adversely impacted prognosis, especially in the young.

摘要

背景

关于心力衰竭（HF）合并症对 HF 预后的影响的数据很少，尤其是在年轻的 HF 患者中。

目的

研究 HF 患者与匹配对照者之间预先存在的合并症，并评估其对死亡率的影响。

方法

我们纳入了 1995 年至 2017 年期间所有首次住院和门诊 HF 诊断以及丹麦全国登记处中 HF 诊断前的合并症。HF 患者与最多 5 名对照者相匹配。估计了三个单独年龄组（≤50 岁、51-74 岁和>74 岁）的 1 年全因死亡率和人群归因风险（PAR）。

结果

共纳入 280022 例 HF 患者和 1166773 例对照者。心血管合并症，如脑血管病和缺血性心脏病在年龄最大的患者中更为常见（HF 中分别为 17.9%和 29.7%，对照者中分别为 9.8%和 10.7%），而在年龄最小的患者中则较为少见（HF 中分别为 3.9%和 15.2%，对照者中分别为 0.7%和 0.9%）。在 HF 患者中，1 年死亡率（每 100 人年）在合并>1 种非心血管合并症的患者中最高：≤50 岁（10.4；9.64-11.3）、51-74 岁（23.3；22.9-23.7）、>74 岁（58.5；57.9-59.0）；危险比分别为 245.18（141.45-424.76）、45.85（42.77-49.15）和 24.5（23.64-25.68），分别用于≤50 岁、51-74 岁和>74 岁的患者。对于≤50 岁的 HF 患者，高血压（17.8%）、癌症（14.1%）和酒精滥用（8.5%）的 PAR 最高。对于>74 岁的患者，高血压（23.6%）、脑血管病（6.2%）和癌症（7.2%）的 PAR 最高。