Méndez-Bailon Manuel, Iguarán-Bermudez Rosario, Formiga-Pérez Francesc, Arévalo Lorido José Carlos, Suárez-Pedreira Iván, Morales-Rull Jose Luis, Serrado-Iglesias Ana, Llacer-Iborra Pau, Ormaechea-Gorricho Gabriela, Carrasco-Sánchez Francisco Javier, Casado-Cerrada Jesús, Andrès Emmanuel, Diez-Manglano Jesús, Lorenzo-Villalba Noel, Montero-Pérez-Barquero Manuel
Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain.
J Clin Med. 2022 Mar 28;11(7):1876. doi: 10.3390/jcm11071876.
Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410−2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality.
心力衰竭（HF）是一种高患病率的综合征，主要影响老年患者，合并症的存在至关重要。方法：进行了一项来自前瞻性登记处的观察性研究。纳入了从西班牙内科协会（SEMI）心力衰竭和心房颤动工作组的国家心力衰竭登记处（RICA）中识别出的患者。后者是一个自2008年起活跃的前瞻性多中心登记处。它包括50岁以上在出院时诊断为HF（急性失代偿性或新发HF）的连续个体患者。结果：从登记处共识别出5424例患者。47%为男性，平均左心室射血分数（LVEF）为51.4%；根据PROFUND指数，1132例得分为0至2分，3087例得分为3至6分，952例患者得分为7至10分。在样本中，252例患者得分高于11分。在随访年末，61%的患者死亡。随着PROFUND指数增加，这种死亡率成比例增加，具体而言，PROFUND大于11的患者死亡率为75%。Kaplan-Meier生存曲线显示，随着PROFUND指数值增加，一年生存率逐渐降低。因此，得分大于7（中高风险和高风险）的受试者生存最差，对数秩为0.96，p<0.05。在回归分析中，我们发现根据PROFUND指数处于最高风险组（得分大于11分（HR 1.838（1.410 - 2.396）））的患者在一年时因任何原因死亡的风险更高。结论：PROFUND指数是预测急性HF入院患者死亡率的良好指标，尤其是在得分高于7的中高风险受试者中。未来研究应试图确定PROFUND指数得分仅仅是一个预后标志物，还是也可用于为那些短期死亡率非常高的受试者做出治疗决策。
