Cardiovascular Division; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Cardiovascular Division.
J Card Fail. 2022 Sep;28(9):1390-1397. doi: 10.1016/j.cardfail.2022.05.004. Epub 2022 May 28.
Patients with heart failure (HF) with preserved ejection fraction are commonly admitted to the hospital for both cardiovascular (CV) and noncardiovascular (non-CV) reasons. The prognostic implications of non-CV hospitalizations in this population are not well understood. In this study, we aimed to examine the prognostic implications of hospitalizations owing to CV and non-CV reasons in a HF with preserved ejection fraction population.
The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT) randomized 3445 stable outpatients with chronic HF with a left ventricular ejection fraction of 45% or greater and either prior hospitalization for HF or elevated natriuretic peptides to treatment with spironolactone or placebo. Hospitalizations for any cause were reported by investigators during study follow-up and characterized according to prespecified category causes. This analysis focused on the subset of TOPCAT participants enrolled in the Americas (n = 1767), in which 2973 hospitalizations were observed in 1062 subjects (60%) over a mean follow-up of 3.3 years of study follow-up, of which 1474 (49%) were ascribed to CV causes. Among 1056 first hospitalizations, 478 (45%) were for CV reasons and 578 (55%) for non-CV reasons. Mortality rates were lowest for participants not hospitalized during the trial (3.2 per 100 patient-years [PY]), but similarly elevated after first hospitalization for CV and non-CV reasons (11.0 per 100 PY vs 12.6 per 100 PY, respectively; P = .24). Among those hospitalized for CV reasons, mortality rates were similar after hospitalization for HF and non-CV related reasons (15.2 per 100 PY vs 12.6 per 100 PY; P = .23). Recurrent hospitalization, whether owing to CV or non-CV causes, was associated with a heightened risk for subsequent mortality, with similar death rates after hospitalization twice for CV reasons (18.5 per 100 PY), twice for non-CV reasons (21.6 per 100 PY), or once each for CV and non-CV reasons (18.4 per 100 PY).
Among patients with HF with preserved ejection fraction, hospitalization for any cause is associated with a heightened risk for postdischarge mortality, with an even higher risk associated with recurrent hospitalization. Given the high burden of non-CV hospitalizations in this population, the targeted management of comorbid medical illness may be critical to decreasing morbidity and mortality.
射血分数保留的心力衰竭（HFpEF）患者常因心血管（CV）和非心血管（非-CV）原因住院。该人群中非-CV 住院的预后意义尚不清楚。在这项研究中，我们旨在检查 HFpEF 人群中因 CV 和非-CV 原因住院的预后意义。
保钾利尿剂在射血分数保留的心力衰竭治疗中的应用（TOPCAT）试验将 3445 名患有慢性 HFpEF、左心室射血分数≥45%、既往因 HF 住院或升高的利钠肽的稳定门诊患者随机分为螺内酯或安慰剂治疗组。在研究随访期间，研究者报告了因任何原因住院的情况，并根据预先指定的类别原因进行了描述。本分析集中于在美洲注册的 TOPCAT 参与者子集（n=1767），在 3.3 年的研究随访中，1062 名受试者中有 2973 次住院（平均随访），其中 1474 次（49%）归因于 CV 原因。在 1056 次首次住院中，478 次（45%）为 CV 原因，578 次（55%）为非-CV 原因。在没有住院的患者中，死亡率最低（每 100 患者年 3.2 例），但首次因 CV 和非-CV 原因住院后死亡率同样升高（每 100 患者年分别为 11.0 例和 12.6 例；P=0.24）。因 CV 原因住院的患者中，因 HF 和非-CV 相关原因住院后的死亡率相似（每 100 患者年分别为 15.2 例和 12.6 例；P=0.23）。无论是否因 CV 或非-CV 原因住院，再次住院均与随后死亡风险增加相关，因 CV 原因住院两次的死亡率相似（每 100 患者年 18.5 例），因非-CV 原因住院两次的死亡率相似（每 100 患者年 21.6 例），或因 CV 和非-CV 原因各住院一次的死亡率相似（每 100 患者年 18.4 例）。
在射血分数保留的心力衰竭患者中，因任何原因住院均与出院后死亡率升高相关，再次住院的风险更高。鉴于该人群中非-CV 住院的高负担，针对合并症的医疗管理可能对降低发病率和死亡率至关重要。
