Anderson Lisa, Bayes-Genis Antoni, Bodegård Johan, Mullin Katrina, Gustafsson Stefan, Rosano Giuseppe M C, Sundström Johan
Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
Heart Institute, Hospital Universitari German Trias i Pujol, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain.
Eur Heart J. 2025 Apr 22;46(16):1493-1503. doi: 10.1093/eurheartj/ehaf034.
Ambulatory patients presenting with signs or symptoms of heart failure (HF) should undergo natriuretic peptide testing. Rates of death, HF hospitalization, and healthcare costs were examined in patients thus identified with suspected de novo HF.
This population-based study (REVOLUTION HF) encompassing two large healthcare regions in Sweden examined patients who presented to outpatient care for the first time between 1 January 2015 and 31 December 2020, who had a recorded sign (peripheral oedema) or symptom (dyspnoea) of HF, and whose N-terminal pro-B-type natriuretic peptide (NT-proBNP) measured >300 ng/L within ±30 days of that sign or symptom. Characteristics, outcomes, healthcare patterns, and healthcare costs for these patients were followed for 1 year. Comparisons were made with matched controls without history of HF, its signs, its symptoms, or elevated NT-proBNP.
Overall, 5942 patients (median age 78.7 years; 54% women) presented with suspected de novo HF. Within 1 year, 29% had received a HF diagnosis. Patients with suspected de novo HF had higher rates of all-cause death (11.7 vs. 6.5 events/100 person-years) and HF hospitalizations (12.5 vs. 2.2 events/100 person-years) than matched controls (n = 2048), with the highest event rates in the weeks after presentation. Rates were higher with higher NT-proBNP levels. Although some patients already used HF guideline-directed medical therapies for other indications, initiation of new medications was variable. Healthcare costs were higher in patients with suspected de novo HF than in matched controls, driven mostly by HF and chronic kidney disease.
Patients with suspected HF and elevated NT-proBNP had high mortality and morbidity in the weeks after presentation, and accrued substantial healthcare costs, highlighting an urgent need for prompt identification, evaluation, and treatment of HF.
出现心力衰竭（HF）体征或症状的门诊患者应接受利钠肽检测。对由此确诊为疑似新发HF的患者的死亡率、HF住院率和医疗费用进行了研究。
这项基于人群的研究（REVOLUTION HF）涵盖瑞典的两个大型医疗区域，研究对象为2015年1月1日至2020年12月31日首次到门诊就诊、有HF记录体征（外周水肿）或症状（呼吸困难）且在该体征或症状出现±30天内测定的N末端B型利钠肽原（NT-proBNP）>300 ng/L的患者。对这些患者的特征、结局、医疗模式和医疗费用进行了1年的跟踪。与无HF病史、无HF体征、无HF症状或NT-proBNP未升高的匹配对照进行比较。
总体而言，5942例患者（中位年龄78.7岁；54%为女性）表现为疑似新发HF。1年内，29%的患者被诊断为HF。疑似新发HF的患者全因死亡率（11.7 vs. 6.5事件/100人年）和HF住院率（12.5 vs. 2.2事件/100人年）高于匹配对照（n = 2048），就诊后几周内事件发生率最高。NT-proBNP水平越高，发生率越高。尽管一些患者已经因其他适应症使用了HF指南指导的药物治疗，但新药物的起始使用情况各不相同。疑似新发HF的患者医疗费用高于匹配对照，主要由HF和慢性肾脏病驱动。
疑似HF且NT-proBNP升高的患者在就诊后几周内死亡率和发病率较高，并产生了大量医疗费用，凸显了对HF进行及时识别、评估和治疗的迫切需求。
