Blumer Vanessa, Mentz Robert J, Sun Jie-Lena, Butler Javed, Metra Marco, Voors Adriaan A, Hernandez Adrian F, O'Connor Christopher M, Greene Stephen J
Division of Cardiology, Duke University School of Medicine, Durham, NC (V.B., R.J.M., A.F.H., S.J.G.).
Duke Clinical Research Institute, Durham, NC (R.J.M., J.-L.S., A.F.H., S.J.G.).
Circ Heart Fail. 2021 Apr;14(4):e007871. doi: 10.1161/CIRCHEARTFAILURE.120.007871. Epub 2021 Mar 29.
Hospitalization for heart failure (HF) is associated with increased risk of death among patients with chronic HF. The degree to which hospitalization for HF is a distinct biologic entity with independent prognostic value versus a marker of higher risk chronic HF patients is unclear.
After excluding patients with new-onset HF, the ASCEND-HF trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) included 4205 patients hospitalized for worsening chronic HF with reduced or preserved ejection fraction. The present analysis compared patients by presence or absence of prior HF hospitalization within 12 months and by timing of prior HF hospitalization relative to index hospitalization. Associations with 180-day all-cause mortality were assessed, including adjustment for 27 prespecified clinical factors.
Overall, 2241 (53.3%) patients had a HF hospitalization within the prior 12 months and 1964 (46.7%) did not. Mortality rates at 180 days were 15.5% and 11.9%, respectively. In unadjusted analyses, prior HF hospitalization was associated with increased risk of 180-day mortality (HR, 1.35 [95% CI, 1.14-1.59]; <0.01). After adjustment, the point estimate was attenuated and the association not statistically significant (HR, 1.18 [95% CI, 0.99-1.40]; =0.064). Similarly, after adjustment, compared with patients without prior hospitalization, prior HF hospitalization was not associated with mortality, irrespective of timing (0-4 months: HR, 1.10 [95% CI, 0.87-1.39], =0.41; 4-8 months: HR, 0.95 [95% CI, 0.70-1.27]; =0.72; 8-12 months: HR, 1.06 [95% CI, 0.74-1.51], =0.77; >12 months: HR, 0.81 [95% CI, 0.63-1.06], =0.12).
In this cohort of patients hospitalized for worsening HF, prior HF hospitalization was not associated with 180-day mortality after comprehensively accounting for patient characteristics measured during the index patient visit. Clinical confounders measured at the point-of-care may explain previously observed associations between prior HF hospitalization and mortality, and these clinical factors may be a more direct means of predicting patient survival. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00475852.
慢性心力衰竭（HF）患者因心力衰竭住院与死亡风险增加相关。心力衰竭住院是一个具有独立预后价值的独特生物学实体，还是慢性心力衰竭高危患者的一个标志，目前尚不清楚。
在排除新发心力衰竭患者后，急性失代偿性心力衰竭奈西立肽临床疗效急性研究（ASCEND-HF试验）纳入了4205例因慢性心力衰竭恶化且射血分数降低或保留而住院的患者。本分析比较了在12个月内有或无既往心力衰竭住院史的患者，以及既往心力衰竭住院时间相对于本次住院的时间。评估了与180天全因死亡率的关联，包括对27个预先设定的临床因素进行调整。
总体而言，2241例（53.3%）患者在既往12个月内有过心力衰竭住院史，1964例（46.7%）患者没有。180天的死亡率分别为15.5%和11.9%。在未调整的分析中，既往心力衰竭住院与180天死亡风险增加相关（HR，1.35[95%CI，1.14-1.59]；P<0.01）。调整后，点估计值减弱，该关联无统计学意义（HR，1.18[95%CI，0.99-1.40]；P=0.064）。同样，调整后，与无既往住院史的患者相比，既往心力衰竭住院与死亡率无关，无论时间如何（0-4个月：HR，1.10[95%CI，0.87-1.39]，P=0.41；4-8个月：HR，0.95[95%CI，0.70-1.27]；P=0.72；8-12个月：HR，1.06[95%CI，0.74-1.51]，P=0.77；>12个月：HR，0.81[95%CI，0.63-1.06]，P=0.12）。
在这组因心力衰竭恶化而住院的患者中，在全面考虑本次住院时测量的患者特征后，既往心力衰竭住院与180天死亡率无关。在床边测量的临床混杂因素可能解释了先前观察到的既往心力衰竭住院与死亡率之间的关联，这些临床因素可能是预测患者生存的更直接方法。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT00475852。
