基于人群的低收入国家心力衰竭流行病学研究：海地心血管疾病队列研究。
Population-Based Epidemiology of Heart Failure in a Low-Income Country: The Haiti Cardiovascular Disease Cohort.
机构信息
Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy).
Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY.
出版信息
Circ Cardiovasc Qual Outcomes. 2023 Feb;16(2):e009093. doi: 10.1161/CIRCOUTCOMES.122.009093. Epub 2022 Dec 6.
BACKGROUND
Cardiovascular disease disproportionately affects persons living in low- and middle-income countries and heart failure (HF) is thought to be a leading cause. Population-based studies characterizing the epidemiology of HF in these settings are lacking. We describe the age-standardized prevalence, survival, subtypes, risk factors, and 1-year mortality of HF in the population-based Haiti Cardiovascular Disease Cohort.
METHODS
Participants were recruited using multistage cluster-area random sampling in Port-au-Prince, Haiti. A total of 2981 completed standardized history and exam, laboratory measures, and cardiac imaging. Clinical HF was defined by Framingham criteria. Kaplan-Meier and Cox proportional hazard regression assessed mortality among participants with and without HF; logistic regression identified associated factors.
RESULTS
Among all participants, the median age was 40 years (interquartile range, 27-55), and 58.2% were female. Median follow-up was 15.4 months (interquartile range, 9-22). The age-standardized HF prevalence was 3.2% (93/2981 [95% CI, 2.6-3.9]). The average age of participants with HF was 57 years (interquartile range, 45-65), and 67.7% were female. The first significant increase in HF prevalence occurred between 30 to 39 and 40 to 49 years (1.1% versus 3.7%, =0.003). HF with preserved ejection fraction was the most common HF subtype (71.0%). Age (adjusted odds ratio, 1.36 [1.12-1.66] per 10-year increase), hypertension (2.14 [1.26-3.66]), obesity (3.35 [95% CI, 1.99-5.62]), poverty (2.10 [1.18-3.72]), and renal dysfunction (5.42 [2.94-9.98]) were associated with HF. One-year HF mortality was 6.6% versus 0.8% (hazard ratio, 7.7 [95% CI, 2.9-20.6]; <0.0001).
CONCLUSIONS
The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%-5-fold higher than modeling estimates for low- and middle-income countries. Adults with HF were two decades younger and 7.7× more likely to die at 1 year compared with those in the community without HF. Further research characterizing the population burden of HF in low- and middle-income countries can guide resource allocation and development of pragmatic HF prevention and treatment interventions, ultimately reducing global cardiovascular disease health disparities.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03892265.
背景
心血管疾病在中低收入国家的人群中发病率更高，心力衰竭（HF）被认为是主要病因。在这些环境中，描述 HF 流行病学的基于人群的研究还很缺乏。我们描述了基于人群的海地心血管疾病队列中 HF 的年龄标准化患病率、生存率、亚型、危险因素和 1 年死亡率。
方法
参与者通过多阶段聚类区域随机抽样在海地太子港招募。共有 2981 人完成了标准化的病史和检查、实验室测量和心脏成像。临床 HF 按照弗雷明汉标准定义。Kaplan-Meier 和 Cox 比例风险回归评估了有和没有 HF 的参与者的死亡率；逻辑回归确定了相关因素。
结果
在所有参与者中，中位年龄为 40 岁（四分位距 27-55），58.2%为女性。中位随访时间为 15.4 个月（四分位距 9-22）。年龄标准化 HF 的患病率为 3.2%（93/2981[95%CI，2.6-3.9]）。HF 患者的平均年龄为 57 岁（四分位距 45-65），67.7%为女性。HF 患病率首次显著增加发生在 30 至 39 岁和 40 至 49 岁之间（1.1%比 3.7%，=0.003）。HF 合并射血分数保留是最常见的 HF 亚型（71.0%）。年龄（调整后的优势比，每增加 10 岁为 1.36[1.12-1.66]）、高血压（2.14[1.26-3.66]）、肥胖（3.35[95%CI，1.99-5.62]）、贫困（2.10[1.18-3.72]）和肾功能障碍（5.42[2.94-9.98]）与 HF 相关。HF 患者的 1 年 HF 死亡率为 6.6%，而社区中无 HF 的患者为 0.8%（风险比，7.7[95%CI，2.9-20.6]；<0.0001）。
结论
在这个低收入环境中，HF 的年龄标准化患病率高得惊人，为 3.2%-5 倍，高于中低收入国家的建模估计。HF 患者比社区中没有 HF 的患者年轻 20 岁，1 年死亡率高 7.7 倍。进一步研究中低收入国家 HF 的人群负担可以指导资源分配和制定实用的 HF 预防和治疗干预措施，最终减少全球心血管疾病的健康差异。
登记
网址：https://www.
临床试验
gov；独特标识符：NCT03892265。
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