我国不同地区急性心力衰竭住院患者的临床特征、诊疗情况及预后差异  

Clinical Characteristics,Management,and One-year Outcome of Patients Hospitalized for Acute Heart Failure in Different Regions of China

作　　者：刘欢梅 张丽华 LIU Huanmei;ZHANG Lihua(National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,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,北京100037

出　　处：《中国循环杂志》2024年第6期592-598,共7页Chinese Circulation Journal

基　　金：国家重点研发计划(2018YFC1312400,2018YFC1312401);国家科技支撑计划(2015BAI12B02);中国医学科学院医学与健康科技创新工程(2021-I2M-1-007)。

摘　　要：目的:分析我国东、中、西部急性心力衰竭(心衰)住院患者的临床特征、院内诊疗情况及出院1年时的预后差异。方法:基于重大慢病国家注册登记研究心衰前瞻队列,连续入选2016年8月至2018年5月全国52家医院≥18岁急性心衰住院患者共4875例,根据我国地域分类分为东部地区(n=1753)、中部地区(n=1723)、西部地区(n=1399)三个地区患者,比较其临床特征、院内诊疗情况及出院1年时的预后差异。结果:所有急性心衰住院患者的中位年龄67(57,75)岁,其中37.5%为女性;合并比例最高的疾病为高血压(56.0%),其次是冠心病(52.1%)、心房颤动(34.3%)和慢性肾脏病(34.3%),其中西部地区患者中高血压合并比例(60.3%)高于东部地区(53.9%)和中部地区(54.7%),差异均有统计学意义(P均<0.017)。在院内用药方面,中部地区患者中β受体阻滞剂、盐皮质激素受体拮抗剂、利尿剂的使用率分别为67.3%、79.9%和85.2%,明显低于东部地区(分别为79.3%、86.3%和89.6%)和西部地区(分别为75.3%、83.6%和89.1%),差异均有统计学意义(P均<0.017)。校正年龄和性别后,三个地区患者出院1年时的全因死亡风险差异无统计学意义,但东部地区患者出院1年时的心血管死亡风险明显高于西部地区患者(HR=1.33,95%CI:1.07~1.65,P<0.017)。结论:我国东、中、西部地区急性心衰住院患者在临床特征及诊疗情况方面存在明显差异,东部地区患者出院1年时的心血管死亡风险高于西部地区患者。Objectives:To analyze the differences in clinical characteristics,in-hospital management and one-year outcome of patients hospitalized for acute heart failure in the eastern,central,and western regions of China.Methods:Data was obtained from the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Prospective Heart Failure Study.A total of 4875 patients aged 18 and above hospitalized for acute heart failure were enrolled from 52 hospitals in China between August 2016 and May 2018.Patients were categorized into three groups according to their geographical locations:eastern(n=1753),central(n=1723),and western(n=1399).The clinical characteristics,in-hospital management,and one-year outcome were compared among the three groups.Results:The included patients had a median age of 67(57,75)years,of whom 37.5%were women.In all patients,the main comorbidities of heart failure included hypertension(56.0%),coronary heart disease(52.1%),atrial fibrillation(34.3%),and chronic kidney disease(34.3%).The proportion of patients with hypertension in the western region(60.3%)was higher than that in the eastern(53.9%)and central regions(54.7%,both P<0.017).The proportions of beta blockers,mineralocorticoid receptor antagonist,and diuretic use during hospitalization in the central region were 67.3%,79.9%and 85.2%,respectively,significantly lower than those in the eastern(79.3%,86.3%and 89.6%)and western(75.3%,83.6%and 89.1%)regions(all<0.017).Arter adjusted for age and sex,there was no statistical difference in all-cause mortality among the three groups during one-year follow-up after discharge,while the risk of cardiovascular mortality in the eastern region was significantly higher than that in the western region within one year after discharge(HR=1.33,95%CI:1.07-1.65,P<0.017).Conclusions:Present results indicate that the clinical characteristics and in-hospital management of patients hospitalized for acute heart failure differ among the eastern,central,and western regions of China.The risk of cardiovascular mortality

关 键 词：心力衰竭 临床特征 预后 地区差异 

分 类 号：R54[医药卫生—心血管疾病]