Goyal Parag, Yum Brian, Navid Pedram, Chen Ligong, Kim Dae H, Roh Jason, Jaeger Byron C, Levitan Emily B
Department of Medicine, Weill Cornell Medicine, New York, New York.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Am J Cardiol. 2021 Jun 1;148:84-93. doi: 10.1016/j.amjcard.2021.02.019. Epub 2021 Mar 3.
Given the role of comorbid conditions in the pathophysiology of HFpEF, we aimed to identify and rank the importance of comorbid conditions associated with post-hospitalization outcomes of older adults hospitalized for HFpEF. We examined data from 4,605 Medicare beneficiaries hospitalized in 2007-2014 for HFpEF based on ICD-9-CM codes for acute diastolic heart failure (428.31 or 428.33). To identify characteristics with high importance for prediction of mortality, all-cause rehospitalization, rehospitalization for heart failure, and composite outcome of mortality or all-cause rehospitalization up to 1 year, we developed boosted decision tree ensembles for each outcome, separately. For interpretability, we estimated hazard ratios (HRs) and 95% confidence intervals (CI) using Cox proportional hazards models. Age and frailty were the most important characteristics for prediction of mortality. Frailty was the most important characteristic for prediction of rehospitalization, rehospitalization for heart failure, and the composite outcome of mortality or all-cause rehospitalization. In Cox proportional hazards models, a 1-SD higher frailty score (0.1 on theoretical range of 0 to 1) was associated with a HR of 1.27 (1.06 to 1.52) for mortality, 1.16 (1.07 to 1.25) for all-cause rehospitalization, 1.24 (1.14 to 1.35) for HF rehospitalization, and 1.15 (1.07 to 1.25) for the composite outcome of mortality or all-cause rehospitalization. In conclusion, frailty is an important predictor of mortality and rehospitalization in adults aged ≥66 years with HFpEF.
鉴于合并症在射血分数保留的心力衰竭(HFpEF)病理生理学中的作用,我们旨在确定与因HFpEF住院的老年人出院后结局相关的合并症的重要性并进行排序。我们检查了2007年至2014年期间因急性舒张性心力衰竭(ICD-9-CM编码为428.31或428.33)而住院的4605名医疗保险受益人的数据。为了确定对死亡率、全因再住院、心力衰竭再住院以及长达1年的死亡率或全因再住院复合结局预测具有高度重要性的特征,我们分别为每个结局开发了增强决策树集成模型。为了便于解释,我们使用Cox比例风险模型估计风险比(HRs)和95%置信区间(CI)。年龄和虚弱是预测死亡率最重要的特征。虚弱是预测再住院、心力衰竭再住院以及死亡率或全因再住院复合结局最重要的特征。在Cox比例风险模型中,虚弱评分每增加1个标准差(理论范围为0至1,增加0.1),死亡率的HR为1.27(1.06至1.52),全因再住院的HR为1.16(1.07至1.25),心力衰竭再住院的HR为1.24(1.14至1.35),死亡率或全因再住院复合结局的HR为1.15(1.07至1.25)。总之,虚弱是≥66岁的HFpEF成人死亡率和再住院的重要预测因素。
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