Perea-Armijo Jorge, López-Aguilera José, González-Manzanares Rafael, Pericet-Rodriguez Cristina, Castillo-Domínguez Juan Carlos, Heredia-Campos Gloria, Roldán-Guerra Álvaro, Urbano-Sánchez Cristina, Barreiro-Mesa Lucas, Aguayo-Caño Nerea, Delgado-Ortega Mónica, Crespín-Crespín Manuel, Ruiz-Ortiz Martín, Mesa-Rubio Dolores, Osorio Manuel Pan-Álvarez, Anguita-Sánchez Manuel
Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain.
Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain.
J Clin Med. 2023 Sep 20;12(18):6082. doi: 10.3390/jcm12186082.
Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term.
A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0-1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed.
The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; = 0.003), chronic kidney disease (36.3% vs. 82.2%; < 0.001), and anaemia (28.8% vs. 53.3%; = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; < 0.001), with differences from the first month.
Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.
心力衰竭病情恶化（WFH）包括因心力衰竭住院，这是射血分数降低的心力衰竭（HFrEF）患者死亡率的一个强有力预测指标。然而，几乎没有证据分析既往心力衰竭住院次数的影响。我们的主要目的是根据既往心力衰竭住院次数分析临床特征及其对中长期的预后影响。
对一组HFrEF患者进行回顾性研究，根据既往住院情况分类：队列1（既往住院0 - 1次）和队列2（既往住院≥2次）。分析临床、超声心动图和治疗变量，并评估住院再入院和心血管死亡率方面的中长期影响。共分析了406例患者。
平均年龄为67.3±12.6岁，男性占优势（73.9%）。约88.9%（361例患者）纳入队列1，45例患者（11.1%）纳入队列2。队列2中房颤（49.9%对73.3%；P = 0.003）、慢性肾脏病（36.3%对82.2%；P < 0.001）和贫血（28.8%对53.3%；P = 0.001）的比例更高。尽管基线心室结构参数相似，但队列1显示出更好的逆向重构。中位随访60个月时，队列1无心力衰竭住院再入院的生存期更长（37.5%对92%；P < 0.001），心血管死亡率更低（26.2%对71.9%；P < 0.001），从第一个月起就存在差异。
既往有≥2次心力衰竭住院的HFrEF患者合并症比例更高。这些患者与更差的逆向重构以及从早期开始就更差的中长期预后相关，其中早期识别对于密切随访和优化强化治疗至关重要。
