Senni M, Tribouilloy C M, Rodeheffer R J, Jacobsen S J, Evans J M, Bailey K R, Redfield M M
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Arch Intern Med. 1999 Jan 11;159(1):29-34. doi: 10.1001/archinte.159.1.29.
To compare the incidence of congestive heart failure and the survival in patients with congestive heart failure in Rochester, Minn, in 1981 with that observed in 1991.
Population-based, descriptive epidemiological study with ecological and individual level comparisons over time. Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes. All 248 patients fulfilled the Framingham criteria, 107 patients presenting with the new onset of congestive heart failure in 1981 and 141 patients in 1991. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of patients at diagnosis.
The incidence of congestive heart failure after adjustment for age and sex to the US population was not significantly different in the 1991 cohort compared with that in 1981 (3.0 per 1000 person-years; 95% confidence interval, 2.5-3.5 vs 2.8 per 1000 person-years; 95% confidence interval, 2.2-3.3; P = .55). The survival of patients with new diagnosis of congestive heart failure was similar in the 2 cohorts (P = .53). Survival adjusted for age, sex, and New York Heart Association functional class was not significantly different in patients with congestive heart failure in 1981 and 1991 (relative risk, 0.907; P = .55).
These data suggest that recent advances in management of cardiovascular disease, as used in the community, had not yet impacted incidence or survival of patients with congestive heart failure in the community during the 10-year study period. This highlights the need to continue efforts to ensure that advances in diagnosis and therapy are incorporated into the care of patients with congestive heart failure in the community.
比较1981年和1991年明尼苏达州罗切斯特市充血性心力衰竭患者的充血性心力衰竭发病率及生存率。
基于人群的描述性流行病学研究，进行不同时间的生态学和个体水平比较。明尼苏达州奥尔姆斯特德县，罗切斯特流行病学项目在此对人群健康结局进行被动监测。所有248例患者均符合弗雷明汉标准，其中1981年有107例新发充血性心力衰竭患者，1991年有141例。回顾所有发病病例的社区住院和门诊医疗记录，以评估患者诊断时的表现特征。
经年龄和性别校正后，1991年队列中充血性心力衰竭的发病率与1981年相比无显著差异（每1000人年3.0例；95%置信区间，2.5 - 3.5 vs每1000人年2.8例；95%置信区间，2.2 - 3.3；P = 0.55）。两个队列中初诊充血性心力衰竭患者的生存率相似（P = 0.53）。1981年和1991年充血性心力衰竭患者经年龄、性别和纽约心脏协会心功能分级校正后的生存率无显著差异（相对风险，0.907；P = 0.55）。
这些数据表明，在为期10年的研究期间，社区中应用的心血管疾病管理方面的最新进展尚未影响社区中充血性心力衰竭患者的发病率或生存率。这凸显了继续努力确保将诊断和治疗方面的进展纳入社区充血性心力衰竭患者护理的必要性。
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