Government Medical College, Kozhikode, Kerala, India.
Office of Clinical Research, Baptist Health South Florida, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Health Science, Universidad Espíritu Santo, Ecuador.
Am J Cardiol. 2023 Sep 15;203:169-174. doi: 10.1016/j.amjcard.2023.07.023. Epub 2023 Jul 25.
Transthyretin amyloid cardiomyopathy is being increasingly recognized as an important cause of heart failure (HF). In this study, we looked at adverse outcomes in hospitalizations with amyloid-related HF. This study was a retrospective analysis of the National Inpatient Sample data, collected from 2016 to 2019. Patients ≥41 years of age and admitted for HF were included in the study. In these hospitalizations, amyloid-related HF was identified through the International Classification of Diseases, Tenth Revision, Clinical Modification codes for amyloidosis. The primary outcome of the study was in-hospital mortality, whereas secondary outcomes were prolonged length of stay, mechanical ventilation, mechanical circulatory support, vasopressors use, and dispositions other than home. From 2016 to 2019, there were 4,705,274 HF hospitalizations, of which 16,955 (0.4%) had amyloid cardiomyopathy. In all HF hospitalizations, amyloid-related increased from 0.26% in 2016 to 0.46% in 2019 (relative increase, 76.9%, P for trend <0.001). Amyloid-related HF hospitalizations were more common in older, male, and Black patients. The odds of in-hospital mortality (odds ratio [OR], 1.29; 95% confidence interval [CI]: 1.11 to 1.38), prolonged hospital length (OR, 1.61; 95% CI: 1.49 to 1.73) and vasopressors use (OR, 1.59; 95% CI: 1.23 to 2.05) were significantly higher for amyloid-related hospitalizations. Amyloid-related HF hospitalizations are increasing substantially and are associated with adverse hospital outcomes. These hospitalizations were disproportionately higher for older, male, and Black patients. Amyloid-related HF is rare and underdiagnosed yet has several adverse outcomes. Hence, healthcare providers should be watchful of this condition for early identification and prompt management.
转甲状腺素蛋白淀粉样心肌病正日益被视为心力衰竭（HF）的一个重要病因。在本研究中，我们观察了与淀粉样变相关 HF 住院的不良结局。本研究为回顾性分析，纳入了 2016 年至 2019 年国家住院患者样本数据。年龄≥41 岁并因 HF 入院的患者纳入本研究。在这些住院患者中，通过国际疾病分类第 10 次修订版临床修正编码来识别与淀粉样变性相关的 HF。本研究的主要结局为院内死亡率，次要结局为住院时间延长、机械通气、机械循环支持、血管加压素使用和非出院处置。2016 年至 2019 年，有 4705274 例 HF 住院患者，其中 16955 例（0.4%）患有淀粉样心肌病。在所有 HF 住院患者中，与淀粉样变相关的 HF 比例从 2016 年的 0.26%增加到 2019 年的 0.46%（相对增加 76.9%，趋势 P<0.001）。与淀粉样变相关的 HF 住院患者更常见于年龄较大、男性和黑人患者。院内死亡率（比值比 [OR]，1.29；95%置信区间 [CI]：1.11 至 1.38）、住院时间延长（OR，1.61；95% CI：1.49 至 1.73）和血管加压素使用（OR，1.59；95% CI：1.23 至 2.05）的可能性对于与淀粉样变相关的住院患者明显更高。与淀粉样变相关的 HF 住院患者显著增加，与不良住院结局相关。这些住院患者中年龄较大、男性和黑人患者的比例更高。与淀粉样变相关的 HF 较为罕见且诊断不足，但具有多种不良结局。因此，医疗保健提供者应注意这种情况，以便早期识别和及时治疗。
