Arora Sameer, Patil Nikita S, Strassle Paula D, Qamar Arman, Vaduganathan Muthiah, Fatima Amber, Mogili Kalyan, Garipalli Deepak, Grodin Justin L, Vavalle John P, Fonarow Gregg C, Bhatt Deepak L, Pandey Ambarish
Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
JACC CardioOncol. 2020 Dec 15;2(5):710-718. doi: 10.1016/j.jaccao.2020.10.007. eCollection 2020 Dec.
The burden of amyloidosis among hospitalized patients is increasing over time. However, amyloidosis remains an underdiagnosed cause of heart failure (HF) hospitalization among older adults.
We investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF.
All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes.
Of 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80).
In patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.
随着时间的推移，住院患者中淀粉样变性的负担在增加。然而，在老年人中，淀粉样变性仍然是心力衰竭（HF）住院的一个诊断不足的原因。
我们调查了因HF住院患者中淀粉样变性的患病率及其对预后的影响。
在全国再入院数据库中确定的2010年1月1日至2015年8月31日期间因HF初次诊断而住院的所有患者，被分为有和没有淀粉样变性二级诊断的两组。然后，根据入院年份、出院季度、年龄、性别和查尔森合并症指数，将伴有淀粉样变性的HF住院患者与不伴有淀粉样变性的HF住院患者按3:1的比例进行匹配。主要结局是住院死亡率和30天再入院率。采用多变量逻辑回归来估计伴有淀粉样变性的HF与临床结局之间的关联。
在符合纳入标准的1,593,360例HF住院患者中，2,846例（0.18%）患有伴有淀粉样变性二级诊断的HF，并与8,515例不伴有淀粉样变性的HF住院患者进行了匹配。与不伴有淀粉样变性的HF相比，伴有淀粉样变性的HF住院患者肾病患病率更高（56%对45%）、恶性肿瘤患病率更高（20%对4%），住院死亡率也更高（6%对3%）。在调整分析中，伴有淀粉样变性的HF与更高的院内死亡率（比值比：1.46；95%置信区间[CI]：1.17至1.82）、30天再入院率（比值比：1.17；95%CI：1.05至1.31）以及更长的平均住院时间（最小二乘均值差异：1.46；95%CI：1.12至1.80）相关。
在失代偿性HF住院患者中，淀粉样变性的存在与更高的住院死亡率和30天再入院风险相关。
