特发性肺纤维化患者左心衰竭负担与死亡率：一项基于人群的研究。
Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study.
机构信息
National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.
NIHR Imperial Biomedical Research Centre, London, UK.
出版信息
BMC Pulm Med. 2022 May 12;22(1):190. doi: 10.1186/s12890-022-01973-5.
BACKGROUND
Cardiovascular disease is prevalent in idiopathic pulmonary fibrosis (IPF), yet the extent of left-sided heart failure (HF) burden, whether this has changed with time and whether HF impacts mortality risk in these patients are unknown. The aims of this study were therefore to determine the temporal trends in incidence and prevalence of left-sided HF in patients with IPF in England and compare these to published estimates in the general population and those with comparable chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), as well as determine the risk of all-cause and cause-specific mortality in patients with comorbid left-sided HF and IPF at population-level using electronic healthcare data.
METHODS
Clinical Practice Research Datalink (CPRD) Aurum primary-care data linked to mortality and secondary-care data was used to identify IPF patients in England. Left-sided HF prevalence and incidence rates were calculated for each calendar year between 2010 and 2019, stratified by age and sex. Risk of all-cause, cardiovascular and IPF-specific mortality was calculated using multivariate Cox regression.
RESULTS
From 40,577patients with an IPF code in CPRD Aurum, 25, 341 IPF patients met inclusion criteria. Left-sided HF prevalence decreased from 33.4% (95% CI 32.2-34.6) in 2010 to 20.9% (20.0-21.7) in 2019. Left-sided HF incidence rate per 100 person-years (95% CI) remained stable between 2010 and 2017 but decreased from 4.3 (3.9-4.8) in 2017 to 3.4 (3.0-3.9) in 2019. Throughout follow-up, prevalence and incidence were higher in men and with increasing age. Comorbid HF was associated with poorer survival (adjusted HR (95%CI) 1.08 (1.03-1.14) for all-cause mortality; 1.32 (1.09-1.59) for cardiovascular mortality).
CONCLUSION
Left-sided HF burden in IPF patients in England remains high, with incidence almost 4 times higher than in COPD, a comparable lung disease with similar cardiovascular risk factors. Comorbid left-sided HF is also a poor prognostic marker. More substantial reduction in left-sided HF prevalence than incidence suggests persistently high IPF mortality. Given rising IPF incidence in the UK, this calls for better management of comorbidities such as left-sided HF to help optimise IPF survival.
背景
特发性肺纤维化（IPF）患者中常见心血管疾病，但左心衰竭（HF）的负担程度、随着时间的推移是否有所变化以及 HF 是否会影响这些患者的死亡率尚不清楚。因此，本研究的目的是确定英格兰 IPF 患者左心 HF 的发病率和患病率的时间趋势，并将其与一般人群以及慢性阻塞性肺疾病（COPD）等具有可比性的慢性呼吸系统疾病患者的公布估计值进行比较，同时使用电子医疗保健数据确定合并左心 HF 和 IPF 的患者在人群水平上的全因和特定原因死亡率的风险。
方法
使用临床实践研究数据链接（CPRD）Aurum 初级保健数据，将死亡数据和二级保健数据进行链接，以确定英格兰的 IPF 患者。计算 2010 年至 2019 年期间每年的左心 HF 患病率和发病率，按年龄和性别分层。使用多变量 Cox 回归计算全因、心血管和 IPF 特异性死亡率的风险。
结果
在 CPRD Aurum 中，有 40577 名患者有 IPF 代码，其中有 25341 名患者符合纳入标准。左心 HF 的患病率从 2010 年的 33.4%（95%CI 32.2-34.6）降至 2019 年的 20.9%（20.0-21.7）。2010 年至 2017 年间，每 100 人年的左心 HF 发病率（95%CI）保持稳定，但 2017 年从 4.3（3.9-4.8）降至 2019 年的 3.4（3.0-3.9）。在整个随访期间，男性和年龄较大的患者中，HF 的患病率和发病率均较高。合并 HF 与较差的生存率相关（全因死亡率的调整 HR（95%CI）为 1.08（1.03-1.14）；心血管死亡率为 1.32（1.09-1.59））。
结论
英格兰 IPF 患者的左心 HF 负担仍然很高，发病率几乎是 COPD 的 4 倍，后者是一种具有相似心血管危险因素的可比肺部疾病。合并左心 HF 也是预后不良的标志物。左心 HF 的患病率下降幅度大于发病率，这表明 IPF 的死亡率持续居高不下。鉴于英国 IPF 的发病率不断上升，这需要更好地管理合并症，如左心 HF，以帮助优化 IPF 的生存率。
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