急性心力衰竭住院患者出院后2年内生存情况分析  

Two-year Survival Analysis of Patients Hospitalized for Acute Heart Failure in China

作　　者：张丽华 蒲博轩 陈腾 赫广达 季润青 田傲溪 雷璐碧 苏小茗 李京阔 ZHANG Lihua;PU Boxuan;CHEN Teng;HE Guangda;JI Runqing;TIAN Aoxi;LEI Lubi;SU Xiaoming;LI Jingkuo(National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院、国家心血管疾病临床医学研究中心,北京市100037

出　　处：《中国循环杂志》2023年第3期284-290,共7页Chinese Circulation Journal

基　　金：国家科技部国家重点研发计划(2018YFC1312400、2018YFC1312401);国家科技支撑计划(2015BAI12B02)。

摘　　要：目的:分析急性心力衰竭(心衰)住院患者出院后2年内的死亡情况、死因及死亡影响因素。方法:从重大慢病国家注册登记研究心衰前瞻队列研究中选取2016年8月至2018年5月全国52家医院的4582例急性心衰住院患者,按左心室射血分数(LVEF)分为射血分数降低的心衰(HFrEF,LVEF<40%,n=1999)、射血分数轻度降低的心衰(HFmrEF,40%≤LVEF<50%,n=885)、射血分数保留的心衰(HFpEF,LVEF≥50%,n=1698)三类。于患者出院后1、6、12、24个月随访,收集死亡与死因信息,分析心衰患者出院后2年内的死亡情况、死因及死亡影响因素。结果:患者中位年龄为67(57,75)岁,37.2%为女性。出院后2年内,1233例(26.9%)患者死亡,其中心血管死亡744例(16.2%),非心血管死亡170例(3.7%),死因不明319例(7.0%)。多因素Cox分析显示,HFmrEF、HFpEF患者2年内全因死亡(分别为:HR=0.69,95%CI:0.59~0.81;HR=0.58,95%CI:0.51~0.67)和心血管死亡(分别为:HR=0.72,95%CI:0.59~0.88;HR=0.48,95%CI:0.40~0.58)风险均低于HFrEF患者(P均<0.01)。在三类心衰患者中,心血管死亡均为最主要的死因,HFrEF患者中心血管死亡比例高于HFmrEF患者和HFpEF患者(19.9%vs.16.5%vs.11.8%,P<0.01)。除年龄、合并症等常见临床因素外,生活质量较差、抑郁、认知功能障碍等以患者为中心的健康状态相关因素也与全因死亡和心血管死亡风险增加有关。结论:约四分之一的急性心衰患者在出院后2年内死亡,心血管原因为主要死因,HFrEF患者的长期死亡风险高于HFmrEF患者和HFpEF患者。常见临床因素和以患者为中心的健康状态相关因素均与患者出院后死亡有关。Objectives:To describe the death rate,causes,and risk factors of death among patients hospitalized for acute heart failure(HF)up to 2 years post discharge.Methods:Data were obtained from the hospitalized patients due to acute HF between August 2016 and May 2018 in the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Prospective Heart Failure Study.The study included 4582 patients who were divided into three groups according to left ventricular ejection fraction(LVEF):heart failure with reduced ejection fraction(HFrEF,LVEF<40%,n=1999),heart failure with mildly reduced ejection fraction(HFmrEF,40%≤LVEF<50%,n=885),and heart failure with preserved ejection fraction(HFpEF,LVEF≥50%,n=1698).Data on mortality and causes of death were collected via interviews at 1,6,12,and 24 months after discharge.Death rate,causes and related risk factors were analyzed.Results:The median age was 67(57,75)years and 37.2%patients were women.During the two-year follow up period,1233(26.9%)patients died,among whom 744(16.2%)died due to cardiovascular reasons,170(3.7%)due to non-cardiovascular reasons,and 319(7.0%)with unknown reasons.Multivariable Cox analyses showed that HFmrEF and HFpEF patients had lower risks of allcause death(HFmrEF:HR=0.69,95%CI:0.59-0.81,P<0.01;HFpEF:HR=0.58,95%CI:0.51-0.67,P<0.01)and cardiovascular death(HFmrEF:HR=0.72,95%CI:0.59-0.88,P<0.01;HFpEF:HR=0.48,95%CI:0.40-0.58,P<0.01)compared to HFrEF patients.Cardiovascular reasons remained the primary contributor to death in HFrEF,HFmrEF,and HFpEF patients,however,the rate of cardiovascular death was significantly higher in patients with HFrEF than in patients with HFmrEF or HFpEF(19.9%vs.16.5%vs.11.8%,P<0.01).Besides the clinical factors(age and comorbidities),patient-centered factors,including poor quality of life,depression,and cognitive impairment were also associated with increased risks of all-cause and cardiovascular death in this patient cohort.Conclusions:Our results indicated that one in four patients died within 2 years after discharg

关 键 词：心力衰竭 死亡 死因 左心室射血分数 风险因素 

分 类 号：R54[医药卫生—心血管疾病]