Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX (A.P.).
Brigham and Women's Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, MA (M.V.).
Circulation. 2020 Jul 21;142(3):230-243. doi: 10.1161/CIRCULATIONAHA.120.047019. Epub 2020 Jun 3.
Patients with heart failure (HF) have multiple coexisting comorbidities. The temporal trends in the burden of comorbidities and associated risk of mortality among patients with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are not well established.
HF-related hospitalizations were sampled by stratified design from 4 US areas in 2005 to 2014 by the community surveillance component of the ARIC study (Atherosclerosis Risk in Communities). Acute decompensated HF was classified by standardized physician review and a previously validated algorithm. An ejection fraction <50% was considered HFrEF. A total of 15 comorbidities were abstracted from the medical record. Mortality outcomes were ascertained for up to 1-year postadmission by linking hospital records with death files.
A total of 5460 hospitalizations (24 937 weighted hospitalizations) classified as acute decompensated HF had available ejection fraction data (53% female, 68% white, 53% HFrEF, 47% HFpEF). The average number of comorbidities was higher for patients with HFpEF versus HFrEF, both for women (5.53 versus 4.94; <0.0001) and men (5.20 versus 4.82; <0.0001). There was a significant temporal increase in the overall burden of comorbidities, both for patients with HFpEF (women: 5.17 in 2005-2009 to 5.87 in 2010-2013; men: 4.94 in 2005-2009 and 5.45 in 2010-2013) and HFrEF (women: 4.78 in 2005-2009 to 5.14 in 2010-2013; men: 4.62 in 2005-2009 and 5.06 in 2010-2013; -trend<0.0001 for all). Higher comorbidity burden was significantly associated with higher adjusted risk of 1-year mortality, with a stronger association noted for HFpEF (hazard ratio [HR] per 1 higher comorbidity, 1.19 [95% CI, 1.14-1.25] versus HFrEF (HR, 1.10 [95% CI, 1.05-1.14]; for interaction by HF type=0.02). The associated mortality risk per 1 higher comorbidity also increased significantly over time for patients with HFpEF and HFrEF, as well ( for interaction with time=0.002 and 0.02, respectively) Conclusions: The burden of comorbidities among hospitalized patients with acute decompensated HFpEF and HFrEF has increased over time, as has its associated mortality risk. Higher burden of comorbidities is associated with higher risk of mortality, with a stronger association noted among patients with HFpEF versus HFrEF.
心力衰竭（HF）患者存在多种并存的合并症。射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）患者合并症负担及其相关死亡率的时间趋势尚不清楚。
通过社区监测部分的 ARIC 研究（社区动脉粥样硬化风险），按分层设计从美国 4 个地区抽取与 HF 相关的住院患者样本，时间范围为 2005 年至 2014 年。急性失代偿性 HF 通过标准化医生审查和先前验证的算法进行分类。射血分数<50%被认为是 HFrEF。从病历中提取了 15 种合并症。通过将医院记录与死亡档案相联系，确定了出院后 1 年内的死亡率结果。
共 5460 例（24937 例加权住院患者）被归类为急性失代偿性 HF，有可用的射血分数数据（53%为女性，68%为白人，53%为 HFrEF，47%为 HFpEF）。HFpEF 患者的合并症数量明显高于 HFrEF 患者，女性为 5.53（<0.0001），男性为 5.20（<0.0001）。HFpEF（女性：2005-2009 年为 5.17，2010-2013 年为 5.87；男性：2005-2009 年为 4.94，2010-2013 年为 5.45）和 HFrEF（女性：2005-2009 年为 4.78，2010-2013 年为 5.14；男性：2005-2009 年为 4.62，2010-2013 年为 5.06）的整体合并症负担均显著增加（<0.0001）。更高的合并症负担与更高的 1 年死亡率调整风险显著相关，HFpEF 患者的相关性更强（每增加 1 种合并症的风险比[HR]，1.19[95%CI，1.14-1.25]与 HFrEF（HR，1.10[95%CI，1.05-1.14]；HF 类型的交互作用=0.02）。HFpEF 和 HFrEF 患者的每增加 1 种合并症相关的死亡率风险也随时间显著增加（交互作用与时间的 P 值分别为 0.002 和 0.02）。
急性失代偿性 HFpEF 和 HFrEF 住院患者的合并症负担随时间推移而增加，其相关死亡率风险也随之增加。合并症负担越高，死亡率风险越高，HFpEF 患者的死亡率风险与 HFrEF 患者相比更高。
