Steffen Henning Johann, Abel Noah, Lau Felix, Schmitt Alexander, Reinhardt Marielen, Akin Muharrem, Bertsch Thomas, Rusnak Jonas, Weidner Kathrin, Behnes Michael, Akin Ibrahim, Schupp Tobias
Medical Faculty Mannheim, Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Cardiology, St. Josef-Hospital, Ruhr-Universität Bochum, 44791, Bochum, Germany.
Heart Vessels. 2025 Jan 22. doi: 10.1007/s00380-024-02505-3.
This study investigates the prognosis of acute decompensated heart failure (ADHF) on admission (i.e., primary ADHF) as compared to ADHF onset during course of hospitalization (i.e., secondary ADHF) in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). Limited data regarding the prognostic impact of the timing of onset of ADHF is available. Consecutive patients with HFmrEF and ADHF were retrospectively included at one institution from 2016 to 2022. Patients with primary ADHF were compared to patients with secondary ADHF with regard to the primary endpoint all-cause mortality at 30 months. Kaplan-Meier, uni- and multivariable Cox proportional regression analyses were applied for statistics. From a total of 484 patients hospitalized with HFmrEF and ADHF, 67.98% (n = 329) were admitted with primary ADHF. Patients with secondary ADHF had higher rates of concomitant acute myocardial infarction, alongside with a higher extend of coronary artery disease. The risk of all-cause mortality at 30 months was not affected by the timing of ADHF (hazard ratio (HR) = 0.853; 95% confidence interval (CI) 0.653-1.115; p = 0.246). However, patients with primary ADHF were associated with a higher risk of HF-related rehospitalization at 30 months (HR = 2.513; 95% CI 1.555-4.065; p = 0.001), which was still evident after multivariable adjustment (HR = 2.347; 95% CI 1.418-3.883; p = 0.001). The timing of onset of ADHF was not associated with long-term mortality in HFmrEF, however primary ADHF was associated with a higher risk of HF-related rehospitalization.
本研究调查了射血分数轻度降低的心力衰竭（HFmrEF）住院患者入院时急性失代偿性心力衰竭（ADHF，即原发性ADHF）与住院期间ADHF发作（即继发性ADHF）的预后情况。关于ADHF发作时间的预后影响的数据有限。2016年至2022年期间，在一家机构对连续性HFmrEF和ADHF患者进行了回顾性纳入。将原发性ADHF患者与继发性ADHF患者在30个月时的主要终点全因死亡率方面进行比较。采用Kaplan-Meier法、单变量和多变量Cox比例回归分析进行统计。在总共484例因HFmrEF和ADHF住院的患者中，67.98%（n = 329）为原发性ADHF入院。继发性ADHF患者伴有急性心肌梗死的发生率更高，同时冠状动脉疾病的范围更广。ADHF发作时间不影响30个月时的全因死亡风险（风险比（HR）= 0.853；95%置信区间（CI）0.653 - 1.115；p = 0.246）。然而，原发性ADHF患者在30个月时与心力衰竭相关再住院风险较高相关（HR = 2.513；95% CI 1.555 - 4.065；p = 0.001），多变量调整后仍然显著（HR = 2.347；95% CI 1.418 - 3.883；p = 0.001）。ADHF发作时间与HFmrEF患者的长期死亡率无关，然而原发性ADHF与心力衰竭相关再住院风险较高相关。
