Institut Català de la Salut, Barcelona, Spain.
Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Scand J Prim Health Care. 2020 Dec;38(4):473-480. doi: 10.1080/02813432.2020.1844387. Epub 2020 Nov 17.
To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Prospective cohort study with a 30-d follow-up from an index consultation. Regression models to determine independent factors associated with hospitalisation or death.
Primary care in ten European countries. Patients with diagnosis of heart failure attended in primary care for a heart failure decompensation (increase of dyspnoea, unexplained weight gain or peripheral oedema).
Potential precipitating factors for decompensation of heart failure and their association with the event of hospitalisation or mortality 30 d after a decompensation.
Of 692 patients 54% were women, mean age 81 (standard deviation [SD] 8.9) years; mean left ventricular ejection fraction (LVEF) 55% (SD 12%). Most frequently identified heart failure precipitation factors were respiratory infections in 194 patients (28%), non-compliance of dietary recommendations in 184 (27%) and non-compliance with pharmacological treatment in 157 (23%). The two strongest precipitating factors to predict 30 d hospitalisation or death were respiratory infections (odds ratio [OR] 2.8, 95% confidence interval [CI] (2.4-3.4)) and atrial fibrillation (AF) > 110 beats/min (OR 2.2, CI 1.5-3.2). Multivariate analysis confirmed the association between the following variables and hospitalisation/death: In relation to precipitating factors: respiratory infection (OR 1.19, 95% CI 1.14-1.25) and AF with heart rate > 110 beats/min (OR 1.22, 95% CI 1.10-1.35); and regarding patient characteristics: New York Heart Association (NYHA) III or IV (OR 1.22, 95% CI 1.15-1.29); previous hospitalisation (OR 1.15, 95% CI 1.11-1.19); and LVEF < 40% (OR 1.14, 95% CI 1.09-1.19).
In primary care, respiratory infections and rapid AF are the most important precipitating factors for hospitalisation and death within 30 d following an episode of heart failure decompensation. Key points Hospitalisation due to heart failure decompensation represents the highest share of healthcare costs for this disease. So far, no primary care studies have analysed the relationship between precipitating factors and short term prognosis of heart failure decompensation episodes. We found that in 692 patients with heart failure decompensation in primary care, the respiratory infection and rapid atrial fibrillation (AF) increased the risk of short-term hospital admission or death. Patients with a hospital admission the previous year and a decompensation episode caused by respiratory infection were even more likely to be hospitalized or die within 30 d.
评估初级保健中心心力衰竭失代偿的诱发因素及其与短期预后的关系。
这是一项前瞻性队列研究，对指数就诊后的 30 天进行随访。采用回归模型确定与住院或死亡相关的独立因素。
十个欧洲国家的初级保健中心。心力衰竭的诊断患者因心力衰竭失代偿（呼吸困难加重、不明原因体重增加或外周水肿）在初级保健中心就诊。
心力衰竭失代偿的潜在诱发因素及其与失代偿后 30 天住院或死亡事件的关系。
692 例患者中，54%为女性，平均年龄 81（标准差 8.9）岁；平均左心室射血分数（LVEF）为 55%（标准差 12%）。最常见的心力衰竭诱发因素为 194 例（28%）呼吸道感染、184 例（27%）饮食建议不遵医嘱和 157 例（23%）药物治疗不遵医嘱。预测 30 天住院或死亡的两个最强诱发因素是呼吸道感染（比值比 [OR] 2.8，95%置信区间 [CI]（2.4-3.4））和心房颤动（AF）>110 次/分钟（OR 2.2，CI 1.5-3.2）。多变量分析证实了以下变量与住院/死亡之间的关联：与诱发因素有关：呼吸道感染（OR 1.19，95%CI 1.14-1.25）和 AF 心率>110 次/分钟（OR 1.22，95%CI 1.10-1.35）；与患者特征有关：纽约心脏协会（NYHA）III 或 IV 级（OR 1.22，95%CI 1.15-1.29）；既往住院（OR 1.15，95%CI 1.11-1.19）；和 LVEF<40%（OR 1.14，95%CI 1.09-1.19）。
在初级保健中，呼吸道感染和快速性心房颤动是心力衰竭失代偿后 30 天内住院和死亡的最重要诱发因素。
心力衰竭失代偿导致的住院治疗占该病医疗费用的最大份额。迄今为止，尚无初级保健研究分析心力衰竭失代偿发作的诱发因素与短期预后之间的关系。我们发现，在 692 例因心力衰竭失代偿在初级保健中心就诊的患者中，呼吸道感染和快速性心房颤动（AF）增加了短期住院或死亡的风险。过去一年住院且因呼吸道感染导致失代偿的患者，在 30 天内住院或死亡的风险更高。
