Yeo Yong-Hao, San Boon-Jian, Mee Xuan-Ci, Tan Min Choon, Abbas Amr E, Shanmugasundaram Madhan, Lee Justin Z, Abidov Aiden, Lee Kwan S
Department of Internal Medicine-Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
Department of Internal Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, NY.
Am J Med. 2025 Jan;138(1):51-60.e2. doi: 10.1016/j.amjmed.2024.09.002. Epub 2024 Sep 14.
Real-world mortality data regarding heart failure in patients with comorbid chronic kidney disease remains limited, especially following the advent of advanced heart failure therapies.
Using the CDC WONDER database, we included patients ≥ 25 years old who died primarily from heart failure (2011-2020) with comorbid chronic kidney disease. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals. We determined the trends over time by estimating the annual percent change (APC) using the Joinpoint regression program.
There were 82,454 heart failure deaths with comorbid chronic kidney disease. The AAMR increased from 2.34 (95% CI, 2.28-2.41) in 2011 to 4.79 (95% CI, 4.71-4.88) in 2020. During the study period, Heart failure deaths among patients with comorbid chronic kidney disease increased by 149.0% compared to 59.9% in those without. Men had higher AAMR than women (3.92 [95% CI, 3.88-3.96] vs. 2.96 [95% CI, 2.93-2.99]). African American patients had the highest AAMR (5.85 [95% CI, 5.75-5.96]). The Midwest region had the highest AAMR (3.83 [95% CI, 3.78-3.89]). The AAMR was higher in the rural areas than in the urban regions (3.77 [95% CI, 3.71-3.83] vs. 3.23 [95% CI, 3.20-3.25]). Most patients died in hospices or nursing homes (29,000, 35.2%).
Our study showed a significant increase in heart failure AAMR in patients with comorbid chronic kidney disease in recent eras. Further effort is needed to optimize cardioprotective agents for this population and to address demographic discrepancies at the policy level.
关于合并慢性肾脏病的心力衰竭患者的真实世界死亡率数据仍然有限，尤其是在晚期心力衰竭治疗出现之后。
使用美国疾病控制与预防中心的WONDER数据库，我们纳入了年龄≥25岁、主要死于心力衰竭（2011 - 2020年）且合并慢性肾脏病的患者。我们计算了每10万人的年龄调整死亡率（AAMR）。我们使用Joinpoint回归程序通过估计年度百分比变化（APC）来确定随时间的趋势。
有82454例合并慢性肾脏病的心力衰竭死亡病例。年龄调整死亡率从2011年的2.34（95%置信区间，2.28 - 2.41）增至2020年的4.79（95%置信区间，4.71 - 4.88）。在研究期间，合并慢性肾脏病的患者中，心力衰竭死亡人数比未合并慢性肾脏病的患者增加了149.0%，而未合并慢性肾脏病的患者增加了59.9%。男性的年龄调整死亡率高于女性（3.92 [95%置信区间，3.88 - 3.96] 对 2.96 [95%置信区间，2.93 - 2.99]）。非裔美国患者的年龄调整死亡率最高（5.85 [95%置信区间，5.75 - 5.96]）。中西部地区的年龄调整死亡率最高（3.83 [95%置信区间，3.78 - 3.89]）。农村地区的年龄调整死亡率高于城市地区（3.77 [95%置信区间，3.71 - 3.83] 对 3.23 [95%置信区间，3.20 - 3.25]）。大多数患者死于临终关怀机构或养老院（29000例，35.2%）。
我们的研究表明，近年来合并慢性肾脏病的心力衰竭患者的年龄调整死亡率显著增加。需要进一步努力为该人群优化心脏保护药物，并在政策层面解决人口统计学差异问题。
