Chouairi Fouad, Miller P Elliott, Loriaux Daniel B, Katz Jason N, Sen Sounok, Ahmad Tariq, Fudim Marat
Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Am J Cardiol. 2023 May 1;194:93-101. doi: 10.1016/j.amjcard.2023.01.012. Epub 2023 Mar 6.
There is limited large, national data investigating the prevalence, characteristics, and outcomes of cardiac arrest (CA) in patients hospitalized for heart failure (HF). The goal of this study was to examine the characteristics, trends, and outcomes of HF hospitalizations complicated by in-hospital CA. We used the National Inpatient Sample to identify all primary HF admissions from 2016 to 2019. Cohorts were built based on the presence of a codiagnosis of CA. Diagnoses were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Associations with CA were then analyzed using multivariate logistic regression. We identified a total of 4,905,564 HF admissions, 56,170 (1.1%) of which had CA. Hospitalizations complicated by CA were significantly more likely to be male, to have coronary artery disease, renal disease, and less likely to be White (p <0.001, all). Age <65 (odds ratio [OR] 1.18, p <0.001), renal disease (OR 2.41, p <0.001), and coronary artery disease (OR 1.26, p <0.001) had higher odds of CA while female gender (OR 0.84, confidence interval [CI] 0.83 to 0.86, p <0.001) or HFpEF (OR 0.49, CI 0.48 to 0.50, p <0.001) had lower odds of CA. Patients with CA had higher inpatient mortality (CA 54.2% vs no CA 2.1%, p <0.001), which persisted after multivariate adjustment (OR 64.8, CI 63.5 to 66.0, p <0.001). CA occurs in >1 in 1,000 HF hospitalizations and remains a prominent and serious event associated with a high mortality. Further research is needed to examine long-term outcomes and mechanical circulatory support utilization with more granularity in HF patients with in-hospital CA.
目前，针对因心力衰竭（HF）住院患者心脏骤停（CA）的患病率、特征及预后进行调查的大型全国性数据有限。本研究旨在探讨并发院内CA的HF住院患者的特征、趋势及预后。我们利用全国住院患者样本，确定了2016年至2019年期间所有原发性HF住院病例。根据是否并存CA诊断构建队列。使用国际疾病分类第十版临床修订本代码确定诊断。然后采用多因素逻辑回归分析与CA的相关性。我们共确定了4905564例HF住院病例，其中56170例（1.1%）发生了CA。并发CA的住院患者更可能为男性，患有冠状动脉疾病、肾病，且不太可能为白人（所有p<0.001）。年龄<65岁（比值比[OR]1.18，p<0.001）、肾病（OR 2.41，p<0.001）和冠状动脉疾病（OR 1.26，p<0.001）发生CA的几率较高，而女性（OR 0.84，置信区间[CI]0.83至0.86，p<0.001）或射血分数保留的HF（HFpEF，OR 0.49，CI 0.48至0.50，p<0.001）发生CA的几率较低。发生CA的患者住院死亡率更高（CA为54.2%，无CA为2.1%，p<0.001），多因素调整后这一情况仍然存在（OR 64.8，CI 63.5至66.0，p<0.001）。每1000例以上HF住院患者中就有1例发生CA，CA仍然是一个突出且严重的事件，与高死亡率相关。需要进一步研究以更详细地检查并发院内CA的HF患者的长期预后及机械循环支持的使用情况。
