老年和超高龄急性心力衰竭患者的死亡模式：来自日本心力衰竭注册登记研究的启示。

Mode of death in elderly and super-elderly patients with acute heart failure: Insights from Japanese heart failure registry.

机构信息

Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan.

Department of Internal medicine, Osaka Hospital, Osaka, Japan.

出版信息

Clin Cardiol. 2021 Jun;44(6):848-856. doi: 10.1002/clc.23619. Epub 2021 May 8.

DOI:10.1002/clc.23619

PMID:33963771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8207972/

Abstract

BACKGROUND

In Japan, both the prevalence of the elderly and super-elderly and those of acute heart failure (AHF) have been increasing rapidly.

METHODS

This registry was a prospective multicenter cohort, which enrolled a total of 1253 patients with AHF. In this study, 1117 patients' follow-up data were available and were categorized into three groups according to age: <75 years old (nonelderly), 75-84 years old (elderly), and ≥ 85 years old (super-elderly). The endpoint was defined as all-cause death and each mode of death after discharge during the 3-years follow-up period.

RESULTS

Based on the Kaplan-Meier analysis, a gradually increased risk of all-cause death according to age was found. Among the three groups, the proportion of HF death was of similar trend; however, the proportion of infection death was higher in elderly and super-elderly patients. After adjusting for potentially confounding effects using the Cox and Fine-Gray model, the hazard ratio (HR) of all-cause death increased significantly in elderly and super-elderly patients (HR, 2.60; 95% confidence interval [CI], 1.93-3.54 and HR, 5.04; 95% CI, 3.72-6.92, respectively), when compared with nonelderly patients. The highest sub-distribution HR in detailed mode of death was infection death in elderly and super-elderly patients (HR, 4.25; 95% CI, 1.75-10.33 and HR, 10.10; 95% CI, 3.78-27.03, respectively).

CONCLUSIONS

In this population, the risk of all-cause death was found to increase in elderly and super-elderly. Elderly patients and especially super-elderly patients with AHF were at a higher risk for noncardiovascular death, especially infection death.

摘要

背景

在日本，老年人和超高龄人群的患病率以及急性心力衰竭（AHF）的患病率都在迅速增加。

方法

本研究为前瞻性多中心队列研究，共纳入 1253 例 AHF 患者。本研究中，1117 例患者的随访数据可用，并根据年龄分为三组：<75 岁（非老年）、75-84 岁（老年）和≥85 岁（超高龄）。终点定义为 3 年随访期间的全因死亡和出院后每种死亡模式。

结果

根据 Kaplan-Meier 分析，发现全因死亡风险随年龄逐渐增加。在三组中，心力衰竭死亡的比例呈相似趋势；然而，老年和超高龄患者感染死亡的比例更高。使用 Cox 和 Fine-Gray 模型调整潜在混杂因素后，老年和超高龄患者的全因死亡风险比（HR）显著增加（HR，2.60；95%置信区间[CI]，1.93-3.54 和 HR，5.04；95%CI，3.72-6.92），与非老年患者相比。在详细的死亡模式中，最高的亚分布 HR 是老年和超高龄患者的感染死亡（HR，4.25；95%CI，1.75-10.33 和 HR，10.10；95%CI，3.78-27.03）。