CS Milladoiro, Área Sanitaria Integrada Santiago de Compostela, Travesía do Porto, Ames, 15895, PC, Spain.
Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Choupana s/n, Santiago de Compostela, 15706, PC, A Coruña, Spain.
BMC Prim Care. 2024 Jul 25;25(1):271. doi: 10.1186/s12875-024-02506-1.
The management in primary care (PC) of the patients with Heart Failure (HF) is different from the management hospital, in a special way compared to cardiology departments.
To define the characteristics in both phenotypes of HF in prevalent and incident cases of HF in patients recruited in a large PC sample.
We proposed a and longitudinal analyses, in patients of the IBERICAN cohort, that recruited 8,066 patients in the Spanish primary care system, with 15,488 patients-years of follow-up. Of them, 252 patients (3.1%) had diagnoses of HF. HF was classified according to the 2014 guidelines in two groups: HF with a reduced eject fraction or HFrEF (LVEF < 50%) and HF with preserved eject fraction or HFpEF (LVEF ≥ 50%). Recommended treatment was defined as the patient receiving drug treatment with Renin-Angiotensin-System (RAS) blockers with beta-blockers and, optionally, spironolactone. The incidence of new cases of HF was calculated in the 7,814 patients without HF in the inclusion visit. Finally, we analysed which variables associated the onset new cases and get the hazard ratio (HR) with the confidence interval at 95% ([95%CI]). Clinical trials register: NCT02261441 (02/05/2017).
The HFpEF was the most frequent phenotype in prevalent cases (61.1%) and incident cases (73.9%). Patients with HFrEF had a higher prevalence of coronary heart disease (p = 0.008) and PAD (p = 0.028), and no statistically significant differences was observed in the therapeutic groups used between both groups. The incidence of HF was 12.8 cases/1000 inhabitants/year, 35.6% of them was diagnosed in PC. The renin-angiotensin system blockers were more used in PC (60%) and beta-blockers (100%) and spironolactone (60%) in hospital. The female sex showed a protective effect for incident cases (0.51 [0.28-0.92]); and AF (HR [95%CI]: 2.90 [1.51-5.54]), coronary heart disease (HR [95%CI]: 2.18 [1.19-4.00]) and hypertension (HR [95%CI]: 1.91 [1.00-3.64]) increased the risk of developing HF.
HF phenotype more frequent and incident in PC was the HFpEF, but only one third of them are diagnosed in PC level. The female sex showed a protective effect and atrial fibrillation, ischaemic heart disease and hypertension increased the risk of develop HF.
与心脏病学部门相比，基层医疗（PC）中心力衰竭（HF）患者的管理方式有所不同，具有独特的特征。
在大型 PC 样本中招募的 HF 患者中，确定流行和新发 HF 患者中两种 HF 表型的特征。
我们提出了一项横断面和纵向分析，在 IBERICAN 队列的 8066 名患者中进行，这些患者在西班牙基层医疗系统中接受了 15488 名患者年的随访。其中，252 名患者（3.1%）被诊断为 HF。根据 2014 年指南，HF 被分为两组：射血分数降低的 HF 或 HFrEF（LVEF<50%）和射血分数保留的 HF 或 HFpEF（LVEF≥50%）。推荐的治疗方法定义为接受肾素-血管紧张素系统（RAS）阻滞剂联合β受体阻滞剂治疗的患者，如果需要，还可接受螺内酯治疗。在纳入时没有 HF 的 7814 名患者中计算了新发 HF 病例的发生率。最后，我们分析了哪些变量与新发病例相关，并获得了 95%置信区间（[95%CI]）的危险比（HR）。临床试验注册：NCT02261441（2017 年 5 月 2 日）。
HFpEF 是流行病例（61.1%）和新发病例（73.9%）中最常见的表型。HFrEF 患者更常见冠心病（p=0.008）和外周动脉疾病（p=0.028），但两组之间使用的治疗组没有统计学上的显著差异。HF 的发病率为 12.8 例/1000 居民/年，其中 35.6%在 PC 中诊断。PC 中更常使用肾素-血管紧张素系统阻滞剂（60%）和β受体阻滞剂（100%）和螺内酯（60%），而在医院中更常使用。女性对新发病例具有保护作用（0.51 [0.28-0.92]）；房颤（HR [95%CI]：2.90 [1.51-5.54]）、冠心病（HR [95%CI]：2.18 [1.19-4.00]）和高血压（HR [95%CI]：1.91 [1.00-3.64]）增加了发生 HF 的风险。
PC 中更常见和更常见的 HF 表型是 HFpEF，但只有三分之一在 PC 水平诊断。女性表现出保护作用，房颤、缺血性心脏病和高血压增加了发生 HF 的风险。
