Department of Cardiology, King's College Hospital London, London, UK.
School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.
ESC Heart Fail. 2023 Aug;10(4):2648-2655. doi: 10.1002/ehf2.14440. Epub 2023 Jun 25.
Specialist cardiology care is associated with a prognostic benefit in patients with heart failure (HF) with reduced ejection fraction (HFrEF) admitted with decompensated HF. However, up to one third of patients admitted with HF and normal ejection fraction (HFnEF) do not receive specialist cardiology input. Whether this has prognostic implications is unknown.
Data on patients hospitalized with HFnEF from two tertiary centres were analysed. The primary outcome measure was all-cause mortality during follow-up. The secondary outcome was in-hospital mortality. A total of 1413 patients were included in the study. Of these, 23% (n = 322) did not receive in-hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs. 79%, P = 0.03) and respiratory co-morbidities (25% vs. 31%, P = 0.02) compared with those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (New York Heart Association III/IV 83% vs. 75% respectively, P = 0.003; moderate-to-severe peripheral oedema 65% vs. 54%, P < 0.001). Medical management was similar, except for a higher use of diuretics (90% vs. 86%, P = 0.04) and a longer length of stay for patients who received specialist input (9 vs. 4 days, P < 0.001). Long-term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in-hospital mortality (hazard ratio 0.19, confidence interval 0.09-0.43, P < 0.001).
In-hospital cardiology specialist input has no long-term prognostic advantage in patients with HFnEF but is independently associated with reduced in-hospital mortality.
在因射血分数降低的心力衰竭（HFrEF）失代偿而住院的心力衰竭（HF）患者中，专科心脏病学治疗与预后改善相关。然而，多达三分之一的射血分数正常的心力衰竭（HFnEF）患者并未接受专科心脏病学治疗。目前尚不清楚这是否具有预后意义。
对来自两个三级中心的 HFnEF 住院患者的数据进行了分析。主要观察指标是随访期间的全因死亡率。次要观察指标是住院死亡率。共纳入 1413 例患者。其中，23%（n=322）的患者未接受住院期间的专科心脏病学治疗。与未接受专科治疗的患者相比，接受心脏病专家治疗的患者高血压（73%比 79%，P=0.03）和呼吸合并症（25%比 31%，P=0.02）的发生率较低。同样，接受专科治疗的患者临床表现更为严重（纽约心脏协会心功能分级 III/IV 分别为 83%比 75%，P=0.003；中重度外周水肿分别为 65%比 54%，P<0.001）。除利尿剂的使用率较高（90%比 86%，P=0.04）和接受专科治疗的患者住院时间较长（9 天比 4 天，P<0.001）外，两组的药物治疗方案基本相同。接受专科治疗和未接受专科治疗的患者的长期预后相当。然而，专科治疗与住院期间死亡率降低独立相关（风险比 0.19，95%置信区间 0.09-0.43，P<0.001）。
在 HFnEF 患者中，住院期间的心脏病学专科治疗并无长期预后优势，但与住院期间死亡率降低独立相关。
