Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
Am J Cardiol. 2023 May 15;195:17-22. doi: 10.1016/j.amjcard.2023.03.003. Epub 2023 Mar 28.
There is a paucity of evidence on the impact of chronic heart failure (HF) on acute pulmonary embolism (PE) hospitalization outcomes. The aim of this study was to evaluate the in-hospital outcomes of patients with chronic HF and acute PE. A total of 1,391,145 hospitalizations with acute PE from the National Inpatient Sample Database from 2011 to 2019 were included. The database was queried for relevant International Classification of Diseases, Ninth and Tenth Revisions procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes for patients with acute PE were compared in patients with and without a history of chronic HF. Multivariate logistic regression analyses were performed, adjusting for age, race, gender, and statistically significant co-morbidities between cohorts. A p value <0.001 was considered significant. Overall, the mean age was 65.2±16 years; 50.9% of patients were women, and 230,875 patients (16.6%) had chronic HF. The patients in the chronic HF cohort were predominantly older (mean age 69.0 vs 61.4 years) and male (49.9% vs 48.3%). In the multivariate model, chronic HF was associated with increased all-cause mortality (odds ratio [OR] 1.6, 95% confidence interval [CI], 1.57 to 1.63, 10.4% vs 5.7%), acute respiratory distress (OR 1.7, 95% CI 1.70 to 1.74, 39.5% vs 22.1%), cardiac arrest (OR 1.4, 95% CI 1.40 to 1.49, 3.9% vs 2.2%), and cardiogenic shock (OR 3.0, 95% CI 2.85 to 3.06, 4.2% vs 1.2%). All p values were <0.001. In conclusion, patients with PE and chronicHF are associated with increased in-hospital complications compared with patients with PE and without chronic HF. Prospective studies are needed to evaluate optimal management strategies in this population at high risk.
慢性心力衰竭（HF）对急性肺栓塞（PE）住院结局的影响证据有限。本研究旨在评估慢性 HF 合并急性 PE 患者的住院结局。从 2011 年至 2019 年，从国家住院患者样本数据库中纳入了 1391145 例急性 PE 住院患者。通过相关的国际疾病分类、第九和第十修订版程序和诊断代码对数据库进行了查询。比较了有和无慢性 HF 病史的急性 PE 患者的基线特征和住院结局。对两组之间存在统计学意义的合并症进行了多变量逻辑回归分析。p 值<0.001 被认为具有统计学意义。总体而言，患者的平均年龄为 65.2±16 岁；50.9%的患者为女性，230875 例（16.6%）患有慢性 HF。慢性 HF 组的患者年龄较大（平均年龄 69.0 岁 vs 61.4 岁）且男性居多（49.9% vs 48.3%）。在多变量模型中，慢性 HF 与全因死亡率增加相关（比值比 [OR] 1.6，95%置信区间 [CI] 1.57 至 1.63，10.4% vs 5.7%）、急性呼吸窘迫（OR 1.7，95% CI 1.70 至 1.74，39.5% vs 22.1%）、心脏骤停（OR 1.4，95% CI 1.40 至 1.49，3.9% vs 2.2%）和心源性休克（OR 3.0，95% CI 2.85 至 3.06，4.2% vs 1.2%）。所有 p 值均<0.001。总之，与无慢性 HF 的急性 PE 患者相比，患有 PE 和慢性 HF 的患者住院期间并发症更多。需要前瞻性研究来评估该高危人群的最佳管理策略。
