Sato Masayuki, Sakata Yasuhiko, Sato Kenjiro, Nochioka Kotaro, Miura Masanobu, Abe Ruri, Oikawa Takuya, Kasahara Shintaro, Aoyanagi Hajime, Yamanaka Shinsuke, Fujihashi Takahide, Hayashi Hideka, Shiroto Takashi, Sugimura Koichiro, Takahashi Jun, Miyata Satoshi, Shimokawa Hiroaki
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Big Data Medicine Center, Tohoku University, Sendai, Japan.
Int J Cardiol Heart Vasc. 2020 Mar 20;27:100497. doi: 10.1016/j.ijcha.2020.100497. eCollection 2020 Apr.
Since most of the randomized clinical trials for heart failure (HF) were designed to exclude elderly patients, limited data are available on their clinical characteristics, prognosis, and prognostic factors.
We compared clinical characteristics, prognosis, and prognostic factors among Stage C/D HF patients in our CHART-2 Study (N = 4876, mean 69 years, women 32%, 6.3-year follow-up) by age (G1, ≤64 years, N = 1521; G2, 65-74 years, N = 1510; and G3, ≥75 years, N = 1845).
From G1 to G3, the prevalence of women, left ventricular ejection fraction (LVEF) and plasma levels of B-type natriuretic peptide (BNP) increased (all P < 0.001). Similarly, 5-year mortality increased (9.9, 17.3 to 39.9%, P < 0.001) along with a decrease in proportion of cardiovascular death and an increase in non-cardiovascular death in both sexes. While all-cause and cardiovascular mortality was comparable between the sexes, women had significantly lower incidence of non-cardiovascular death than men in G2 and G3, which was attributable to the higher incidence of cancer death and pneumonia death in men than in women. Although NYHA functional class III-IV, chronic kidney disease, cancer, LVEF, and BNP had significant impacts on all-cause death in all groups, their impacts were less evident in G3 as compared with G1.
The elderly HF patients, as compared with younger HF patients, were characterized by more severe clinical background, increased proportion of non-cardiovascular death and worse prognosis with different impacts of prognostic factors across the age groups.
由于大多数心力衰竭（HF）的随机临床试验旨在排除老年患者，因此关于其临床特征、预后和预后因素的数据有限。
我们在CHART-2研究中，根据年龄（G1，≤64岁，N = 1521；G2，65 - 74岁，N = 1510；G3，≥75岁，N = 1845）比较了C/D期HF患者的临床特征、预后和预后因素（N = 4876，平均69岁，女性占32%，随访6.3年）。
从G1到G3，女性患病率、左心室射血分数（LVEF）和B型利钠肽（BNP）血浆水平均升高（所有P < 0.001）。同样，5年死亡率升高（从9.9%、17.3%升至39.9%，P < 0.001），同时男女心血管死亡比例下降，非心血管死亡比例上升。虽然全因死亡率和心血管死亡率在两性之间相当，但在G2和G3中，女性非心血管死亡发生率显著低于男性，这归因于男性癌症死亡和肺炎死亡发生率高于女性。尽管纽约心脏病协会（NYHA）心功能III - IV级、慢性肾脏病、癌症、LVEF和BNP对所有组的全因死亡均有显著影响，但与G1相比，其在G3中的影响较小。
与年轻HF患者相比，老年HF患者具有更严重的临床背景、非心血管死亡比例增加以及预后较差的特点，且不同年龄组的预后因素影响不同。
