Wang Chih-Hung, Ho Li-Ting, Wu Meng-Che, Wu Cheng-Yi, Tay Joyce, Su Pei-I, Tsai Min-Shan, Wu Yen-Wen, Chang Wei-Tien, Huang Chien-Hua, Chen Wen-Jone
Department of Emergency Medicine, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan, Republic of China.
Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Clin Res Cardiol. 2025 May;114(5):557-569. doi: 10.1007/s00392-024-02403-8. Epub 2024 Feb 26.
The 2022 AHA/ACC/HFSA guidelines for the management of heart failure (HF) makes therapeutic recommendations based on HF status. We investigated whether the prognosis of in-hospital cardiac arrest (IHCA) could be stratified by HF stage and left ventricular ejection fraction (LVEF).
This single-center retrospective study analyzed the data of patients who experienced IHCA between 2005 and 2020. Based on admission diagnosis, past medical records, and pre-arrest echocardiography, patients were classified into general IHCA, at-risk for HF, pre-HF, HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction or HF with reduced ejection fraction (HFmrEF-or-HFrEF) groups.
This study included 2,466 patients, including 485 (19.7%), 546 (22.1%), 863 (35.0%), 342 (13.9%), and 230 (9.3%) patients with general IHCA, at-risk for HF, pre-HF, HFpEF, and HFmrEF-or-HFrEF, respectively. A total of 405 (16.4%) patients survived to hospital discharge, with 228 (9.2%) patients achieving favorable neurological recovery. Multivariable logistic regression analysis indicated that pre-HF and HFpEF were associated with better neurological (pre-HF, OR: 2.11, 95% confidence interval [CI]: 1.23-3.61, p = 0.006; HFpEF, OR: 1.90, 95% CI: 1.00-3.61, p = 0.05) and survival outcomes (pre-HF, OR: 2.00, 95% CI: 1.34-2.97, p < 0.001; HFpEF, OR: 1.91, 95% CI: 1.20-3.05, p = 0.007), compared with general IHCA.
HF stage and LVEF could stratify patients with IHCA into different prognoses. Pre-HF and HFpEF were significantly associated with favorable neurological and survival outcomes after IHCA. Further studies are warranted to investigate whether HF status-directed management could improve IHCA outcomes.
2022年美国心脏协会（AHA）/美国心脏病学会（ACC）/美国心力衰竭学会（HFSA）心力衰竭管理指南根据心力衰竭状态提出了治疗建议。我们研究了是否可以根据心力衰竭阶段和左心室射血分数（LVEF）对院内心脏骤停（IHCA）患者的预后进行分层。
这项单中心回顾性研究分析了2005年至2020年间经历IHCA的患者数据。根据入院诊断、既往病历和心脏骤停前超声心动图，将患者分为一般IHCA、心力衰竭风险患者、心力衰竭前期、射血分数保留的心力衰竭（HFpEF）以及射血分数轻度降低或射血分数降低的心力衰竭（HFmrEF或HFrEF）组。
本研究纳入2466例患者，其中一般IHCA、心力衰竭风险患者、心力衰竭前期、HFpEF、HFmrEF或HFrEF患者分别有485例（19.7%）、546例（22.1%）、863例（35.0%）、342例（13.9%）和230例（9.3%）。共有405例（16.4%）患者存活至出院，228例（9.2%）患者实现了良好的神经功能恢复。多变量逻辑回归分析表明，与一般IHCA相比，心力衰竭前期和HFpEF与更好的神经功能（心力衰竭前期，比值比[OR]：2.11，95%置信区间[CI]：1.23 - 3.61，p = 0.006；HFpEF，OR：1.90，95% CI：1.00 - 3.61，p = 0.05）和生存结果（心力衰竭前期，OR：2.00，95% CI：1.34 - 2.97，p < 0.001；HFpEF，OR：1.91，95% CI：1.20 - 3.05，p = 0.007）相关。
心力衰竭阶段和LVEF可将IHCA患者分层为不同的预后情况。心力衰竭前期和HFpEF与IHCA后良好的神经功能和生存结果显著相关。有必要进一步研究心力衰竭状态导向的管理是否能改善IHCA的结局。
