Su Kanae, Kato Takao, Toyofuku Mamoru, Morimoto Takeshi, Yaku Hidenori, Inuzuka Yasutaka, Tamaki Yodo, Ozasa Neiko, Yamamoto Erika, Yoshikawa Yusuke, Motohashi Yasuyo, Watanabe Hiroki, Kitai Takeshi, Taniguchi Ryoji, Iguchi Moritake, Kato Masashi, Nagao Kazuya, Kawai Takafumi, Komasa Akihiro, Nishikawa Ryusuke, Kawase Yuichi, Morinaga Takashi, Jinnai Toshikazu, Kawato Mitsunori, Sato Yukihito, Kuwahara Koichiro, Tamura Takashi, Kimura Takeshi
Japanese Red Cross Wakayama Medical Center Wakayama Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan.
Circ Rep. 2019 Oct 26;1(11):517-524. doi: 10.1253/circrep.CR-19-0054.
We sought to explore the effects of previous heart failure (HF) hospitalization on mortality in patients hospitalized for acute decompensated HF (ADHF) in a large Japanese contemporary observational database. We prospectively enrolled consecutive patients with ADHF in 19 participating hospitals between October 2014 and March 2016. Of 4,056 patients, 1,442 patients (35.4%) had at least 1 previous HF hospitalization (previous hospitalization group), while 2,614 patients (64.5%) did not have a history of HF hospitalization (de novo hospitalization group). Patients with previous hospitalization were older and more often had comorbidities such as anemia, and renal failure than those without. The cumulative 1-year incidence of all-cause death was significantly higher in the previous hospitalization group than in the de novo hospitalization group (28% vs. 19%, P<0.001). After adjusting confounders, the excess risk of the previous hospitalization group relative to the de novo hospitalization group for all-cause death remained significant (HR, 1.28; 95% CI: 1.10-1.50, P=0.001). The excess risk was significant in patients without advanced age, anemia, or renal failure, but not significant in patients with these comorbidities, with significant interaction. Increase in the number of hospitalizations was associated with an increased risk for mortality. In a contemporary ADHF cohort in Japan, repeated hospitalization was associated with an increasing, higher risk for 1-year mortality.
我们试图在一个大型的日本当代观察性数据库中，探究既往心力衰竭（HF）住院史对因急性失代偿性心力衰竭（ADHF）住院患者死亡率的影响。2014年10月至2016年3月期间，我们在19家参与研究的医院中前瞻性地纳入了连续的ADHF患者。在4056例患者中，1442例患者（35.4%）至少有1次既往HF住院史（既往住院组），而2614例患者（64.5%）没有HF住院史（初发住院组）。与无既往住院史的患者相比，既往住院的患者年龄更大，且更常合并贫血和肾衰竭等疾病。既往住院组的全因死亡累积1年发生率显著高于初发住院组（28%对19%，P<0.001）。在调整混杂因素后，既往住院组相对于初发住院组的全因死亡额外风险仍然显著（HR，1.28；95%CI：1.10 - 1.50，P = 0.001）。在无高龄、贫血或肾衰竭的患者中，额外风险显著，但在合并这些疾病的患者中不显著，存在显著的交互作用。住院次数增加与死亡风险增加相关。在日本当代ADHF队列中，重复住院与1年死亡率增加且风险更高相关。
