Xanthopoulos Andrew, Bourazana Angeliki, Matsue Yuya, Fujimoto Yudai, Oishi Shogo, Akiyama Eiichi, Suzuki Satoshi, Yamamoto Masayoshi, Kida Keisuke, Okumura Takahiro, Giamouzis Grigorios, Skoularigis John, Triposkiadis Filippos, Kitai Takeshi
Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece.
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan.
J Clin Med. 2023 May 28;12(11):3722. doi: 10.3390/jcm12113722.
Patients with heart failure (HF) patients may die either suddenly (sudden cardiac death/SCD) or progressively from pump failure. The heightened risk of SCD in patients with HF may expedite important decisions about medications or devices. We used the Larissa Heart Failure Risk Score (LHFRS), a validated risk model for all-cause mortality and HF rehospitalization, to investigate the mode of death in 1363 patients enrolled in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure (REALITY-AHF). Cumulative incidence curves were generated using a Fine-Gray competing risk regression, with deaths that were not due to the cause of death of interest as a competing risk. Likewise, the Fine-Gray competing risk regression analysis was used to evaluate the association between each variable and the incidence of each cause of death. The AHEAD score, a well-validated HF risk score ranging from 0 to 5 (atrial fibrillation, anemia, age, renal dysfunction, and diabetes mellitus), was used for the risk adjustment. Patients with LHFRS 2-4 exhibited a significantly higher risk of SCD (HR hazard ratio adjusted for AHEAD score 3.15, 95% confidence interval (CI) (1.30-7.65), = 0.011) and HF death (adjusted HR for AHEAD score 1.48, 95% CI (1.04-2.09), = 0.03), compared to those with LHFRS 0,1. Regarding cardiovascular death, patients with higher LHFRS had significantly increased risk compared to those with lower LHFRS (HR 1.44 adjusted for AHEAD score, 95% CI (1.09-1.91), = 0.01). Lastly, patients with higher LHFRS exhibited a similar risk of non-cardiovascular death compared to those with lower LHFRS (HR 1.44 adjusted for AHEAD score, 95% CI (0.95-2.19), = 0.087). In conclusion, LHFRS was associated independently with the mode of death in a prospective cohort of hospitalized HF patients.
心力衰竭（HF）患者可能会突然死亡（心源性猝死/SCD），也可能因泵衰竭而逐渐死亡。HF患者发生SCD的风险增加，这可能会加快有关药物或器械的重要决策。我们使用拉里萨心力衰竭风险评分（LHFRS），这是一种经过验证的全因死亡率和HF再住院风险模型，来研究1363名纳入急性心力衰竭急诊室极早期就诊和治疗登记研究（REALITY-AHF）的患者的死亡方式。使用Fine-Gray竞争风险回归生成累积发病率曲线，将非感兴趣死因的死亡作为竞争风险。同样，使用Fine-Gray竞争风险回归分析来评估每个变量与每种死因发生率之间的关联。AHEAD评分是一种经过充分验证的HF风险评分，范围为0至5（心房颤动、贫血、年龄、肾功能不全和糖尿病），用于风险调整。与LHFRS为0、1的患者相比，LHFRS为2-4的患者发生SCD的风险显著更高（校正AHEAD评分后的HR风险比为(3.15)，95%置信区间（CI）为（(1.30 - 7.65)），(P = 0.011)），发生HF死亡的风险也更高（校正AHEAD评分后的HR为(1.48)，95%CI为（(1.04 - 2.09)），(P = 0.03)）。关于心血管死亡，LHFRS较高的患者与LHFRS较低的患者相比，风险显著增加（校正AHEAD评分后的HR为(1.44)，95%CI为（(1.09 - 1.91)），(P = 0.01)）。最后，与LHFRS较低的患者相比，LHFRS较高的患者发生非心血管死亡的风险相似（校正AHEAD评分后的HR为(1.44)，95%CI为（(0.95 - 2.19)），(P = 0.087)）。总之，在一组住院HF患者的前瞻性队列中，LHFRS与死亡方式独立相关。
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