Bertel O
Kardiologische Abteilung, Medizinische Klinik, Stadtspital Triemli, Zürich.
Ther Umsch. 1993 Jun;50(6):388-93.
Congestive heart failure can develop as a complication of virtually all forms of heart diseases. Depending on diagnostic criteria, the figures for prevalence and incidence differ markedly. The frequency of congestive heart failure increases with age and doubles in each life decade. In the United States the prevalence of 1% and for Great Britain 0.4% respectively have been calculated. In the highest age groups up to 90 new cases/1000 population per year can be observed. As a contribution to decreasing mortality of acute myocardial infarction and better treatment of high blood pressure as well as congestive heart failure the number of patients in heart failure have increased substantially. In contrast to the Framingham Study, nowadays coronary artery disease is the most prevalent etiology of congestive heart failure followed by hypertensive heart disease. In younger patient groups with advanced heart failure, like heart transplant recipients, cardiomyopathies are the main etiologic factor. Heart failure is the leading factor for emergency admissions to hospital in adult internal medicine. The main reasons for decompensation are acute ischemic syndromes for acute congestive heart failure and compliance problems for chronic congestive heart failure. The natural history of congestive heart failure is characterized by a marked progression, increasing with the severity of heart failure. In parallel, mortality increases, too. A variety of clinical, hemodynamic neurohumoral and electrophysiologic factors have been described as independent factors predicting prognosis. 30 to 50% of heart failure patients die a sudden death as compared with progressive pump failure or infectious complications in the others.
充血性心力衰竭几乎可作为所有形式心脏病的并发症而发生。根据诊断标准，患病率和发病率数据差异显著。充血性心力衰竭的发生率随年龄增长而增加，每增加一个十年便会翻倍。在美国，据计算患病率为1%，在英国为0.4%。在最高年龄组中，每年每1000人口中可观察到多达90例新病例。由于急性心肌梗死死亡率的降低以及高血压和充血性心力衰竭治疗水平的提高，心力衰竭患者的数量大幅增加。与弗明汉姆研究不同，如今冠状动脉疾病是充血性心力衰竭最常见的病因，其次是高血压性心脏病。在患有晚期心力衰竭的年轻患者群体中，如心脏移植受者，心肌病是主要病因。心力衰竭是成人内科紧急住院的主要原因。失代偿的主要原因在急性充血性心力衰竭中是急性缺血综合征，在慢性充血性心力衰竭中是依从性问题。充血性心力衰竭的自然病程以显著进展为特征，随着心力衰竭严重程度的增加而加重。与此同时，死亡率也会上升。多种临床、血流动力学、神经体液和电生理因素已被描述为预测预后的独立因素。与其他因进行性泵衰竭或感染性并发症死亡的患者相比，30%至50%的心力衰竭患者死于猝死。
