Lindmark Krister, Boman Kurt, Stålhammar Jan, Olofsson Mona, Lahoz Raquel, Studer Rachel, Proudfoot Clare, Corda Stefano, Fonseca Ana Filipa, Costa-Scharplatz Madlaina, Levine Aaron, Törnblom Michael, Castelo-Branco Anna, Kopsida Eleni, Wikström Gerhard
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden.
Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
ESC Heart Fail. 2021 Jun;8(3):2144-2153. doi: 10.1002/ehf2.13296. Epub 2021 Mar 9.
Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden.
Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all-cause mortality were evaluated. A time-dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction-based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient-years of follow-up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all-cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all-cause mortality increased approximately six-fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24-7.48] and 5.59 [4.70-6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities.
There is a strong association between recurrent HFHs and CV and all-cause mortality, with the risk increasing progressively with each recurrent HFH.
心力衰竭（HF）是住院治疗的主要原因，且与高发病率和高死亡率相关。我们研究了复发性心力衰竭住院（HFHs）对瑞典心力衰竭患者心血管（CV）死亡率的影响。
从2005年1月1日至2013年12月31日于乌普萨拉、直至2014年12月31日于韦斯特博滕的全国健康登记链接和电子病历中识别出成年新发HF患者。评估CV死亡率和全因死亡率。使用时间依赖性Cox回归模型估计复发性HFHs的相对CV死亡率。还对基于射血分数的HF表型以及合并房颤、糖尿病或慢性肾功能损害的情况进行了评估。总体而言，纳入了3878例有首次住院的HF患者，提供了9691.9患者年的随访。患者年龄相对较大（中位年龄：80岁），男性更为常见（占55.5%）。与无复发性HFHs的患者相比，有1次、2次、3次以及4次或更多次复发性HFHs的患者，其CV死亡率和全因死亡率的调整后风险比（HR[95%置信区间；CI]）具有统计学意义。与无任何HFHs的患者相比，有4次或更多次复发性HFHs的患者CV死亡率和全因死亡率的风险增加了约6倍（HR[95%CI]分别为：6.26[5.24 - 7.48]和5.59[4.70 - 6.64]）。在HF表型和合并症患者中观察到类似模式。
复发性HFHs与CV死亡率和全因死亡率之间存在密切关联，且风险随每次复发性HFH逐渐增加。
