Grobman Benjamin, Mansur Arian, Lu Christine Y
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
J Clin Med. 2024 Oct 16;13(20):6153. doi: 10.3390/jcm13206153.
Heart failure deaths have increased in recent years in the United States and are projected to continue to increase in the future. Rates of liver disease and cirrhosis have similarly increased in the United States. Patients with cirrhosis are at an elevated risk of heart failure with a worsened prognosis. As such, investigations of the epidemiology of these comorbid conditions are important. We obtained data on heart failure deaths among people with cirrhosis in the United States from 1999 to 2020 from the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research multiple cause of death database. Rates were analyzed for the population as a whole and for demographic subgroups. From 1999 to 2020, there were 7424 cirrhosis-related heart failure deaths. Rates were higher among Black (AAMR ratio = 1.288, 95% CI: 1.282-1.295) and Asian people (AAMR ratio = 3.310, 95% CI: 3.297-3.323) compared to White people. Rates were also higher in rural areas than in urban areas (AAMR ratio = 1.266, 95% CI: 1.261-1.271). Rates increased over time across demographic subgroups. People with cirrhosis are at an elevated risk of heart failure death compared to the general population. Rates were particularly elevated in Asian people, Black people, males, and people living in rural areas. These data indicate a significant and previously underappreciated disease burden. Clinicians taking care of cirrhosis patients should be aware of the risk of heart failure and should collaborate with cardiac specialists as needed.
近年来，美国心力衰竭死亡人数有所增加，预计未来还将继续上升。美国的肝病和肝硬化发病率也同样有所上升。肝硬化患者发生心力衰竭的风险升高，预后更差。因此，对这些合并症的流行病学进行调查很重要。我们从美国疾病控制中心的广泛在线流行病学研究多死因数据库中获取了1999年至2020年美国肝硬化患者心力衰竭死亡的数据。对总体人群和人口亚组的发病率进行了分析。1999年至2020年期间，有7424例与肝硬化相关的心力衰竭死亡病例。与白人相比，黑人（年龄调整死亡率比值=1.288，95%置信区间：1.282-1.295）和亚洲人（年龄调整死亡率比值=3.310，95%置信区间：3.297-3.323）的发病率更高。农村地区的发病率也高于城市地区（年龄调整死亡率比值=1.266，95%置信区间：1.261-1.271）。各人口亚组的发病率随时间增加。与普通人群相比，肝硬化患者发生心力衰竭死亡的风险升高。亚洲人、黑人、男性以及农村地区居民的发病率尤其升高。这些数据表明了一种重大且此前未得到充分认识的疾病负担。照顾肝硬化患者的临床医生应意识到心力衰竭的风险，并应根据需要与心脏专科医生合作。
