Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Tokyo, Japan.
J Cardiol. 2020 Aug;76(2):132-138. doi: 10.1016/j.jjcc.2020.02.008. Epub 2020 Mar 18.
The number of hospitalized patients with heart failure (HF) is increasing as a result of the increase in the elderly population in Japan. We evaluated changes in the characteristics and outcomes of HF patients hospitalized in the 2000s to the 2010s and discharged alive based on left ventricular ejection fraction (LVEF).
Pooled patient data were obtained from The Heart Institute of Japan Heart Failure studies (HIJ-HF I: 2001-2 and HIJ-HF II: 2013-4). We studied patients discharged alive from pooled data based on LVEF < 40% (HFrEF), 40-49% (HFmrEF), and ≥50% (HFpEF). The primary outcome was death from any cause, and the secondary outcomes were cardiac death and rehospitalization due to worsened HF.
The proportion of HFpEF increased (35%-43%, p < 0.01), and the median ages of patients with HFmrEF (72-76 years, p < 0.01) or HFpEF (72-80 years, p < 0.01) increased from HIJ-HF I to HIJ-HF II. The use of angiotensin II receptor blockers, beta-blockers, statins, amiodarone, and erythropoietin increased, but nitrate and digoxin usage decreased. The adjusted survival rate and cardiac death-free rate were not significantly different between the 2000s and 2010s in any LVEF group, and the incidence of rehospitalization due to worsened HF was reduced in patients discharged alive from HIJ-HF I to HIJ-HF II [HFrEF: hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.51-0.89; HFmrEF: HR 0.89, 95% CI 0.68-1.16; and HFpEF: HR 0.77, 95% CI 0.61-0.97] with no significant interaction by LVEF groups.
Our study demonstrated that age, the proportion of HFpEF, and guideline-recommended drug therapy use increased among hospitalized Japanese HF patients from the 2000s to the 2010s. The adjusted survival rate was not improved in any LVEF group, although the incidence of rehospitalization due to worsened HF was reduced.
随着日本老年人口的增加，心力衰竭（HF）住院患者的数量不断增加。我们评估了基于左心室射血分数（LVEF）的 21 世纪 00 年代至 10 年代 HF 患者的特征和结局变化。
从日本心脏研究所心力衰竭研究（HIJ-HF I：2001-2 和 HIJ-HF II：2013-4）中获得汇总患者数据。我们根据 LVEF<40%（HFrEF）、40-49%（HFmrEF）和≥50%（HFpEF），研究了从汇总数据中存活出院的患者。主要结局是任何原因导致的死亡，次要结局是因 HF 恶化而再次住院的心脏死亡。
HFpEF 的比例增加（35%-43%，p<0.01），HFmrEF（72-76 岁，p<0.01）或 HFpEF（72-80 岁，p<0.01）患者的中位年龄从 HIJ-HF I 增加到 HIJ-HF II。血管紧张素 II 受体阻滞剂、β受体阻滞剂、他汀类药物、胺碘酮和促红细胞生成素的使用率增加，但硝酸盐和地高辛的使用率下降。在任何 LVEF 组中，21 世纪 00 年代和 10 年代的调整生存率和心脏死亡无事件率均无显著差异，并且从 HIJ-HF I 出院的患者因 HF 恶化而再次住院的发生率降低[HFrEF：风险比（HR）0.67，95%置信区间（CI）0.51-0.89；HFmrEF：HR 0.89，95% CI 0.68-1.16；HFpEF：HR 0.77，95% CI 0.61-0.97]，LVEF 组之间无显著交互作用。
我们的研究表明，21 世纪 00 年代至 10 年代，日本 HF 住院患者的年龄、HFpEF 比例和指南推荐药物治疗的使用率增加。尽管因 HF 恶化而再次住院的发生率降低，但任何 LVEF 组的调整生存率均未改善。
