A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction.
A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction.
复制标题
DOI：
10.1161/circheartfailure.110.957480
复制
发表时间：
2011-01
期刊：
影响因子：
--
通讯作者：
Vasan RS
中科院分区：
文献类型：
--
作者：
Lee DS;Gona P;Albano I;Larson MG;Benjamin EJ;Levy D;Kannel WB;Vasan RS
心力衰竭(HF)患者的高死亡率受多种并发症的影响。关于社区心力衰竭患者中心血管疾病与非心血管疾病对死亡的相对贡献的数据有限。在Framingham心脏研究中，我们研究了心力衰竭患者心血管和非心血管死亡的发生率和预测因素。潜在的、直接的和促成死亡的原因(世界卫生组织分类的3个关键要素)由一个由3名医生组成的审查小组作出裁决。1971-2004年间，1025名心力衰竭患者死亡(499名男性，平均死亡年龄79岁[11]岁)，包括463名有左心室射血分数(LVEF)数据的参与者。心血管疾病是66.1%的死亡原因。按左心室射血分数分层，左心室射血分数保留组和减少组的心血管死亡发生率分别为44.5%和69.9%。左心室射血分数降低增加了心血管死亡的风险，男性的优势比为3.16(95%可信区间1.73-5.78)，女性为2.39(95%可信区间1.39-4.08)。既往心肌梗死与女性心力衰竭患者心血管死亡增加相关(优势比1.87，95%可信区间1.10-3.16)，但与男性无关。随着时间的推移，患有心力衰竭的女性(1980年后的优势比为0.41，95%可信区间为0.24-0.69)和男性(优势比为0.66，95%可信区间为0.41-1.07，p=0.095)的心血管疾病死亡风险降低。感染和肾脏疾病分别成为主要的直接死亡原因和致死原因。社区中患有心力衰竭的人经常经历心血管死亡，但非心血管疾病也有显著影响，特别是在那些左心室射血分数保留的人中。
The high mortality in patients with heart failure (HF) is influenced by presence of multiple comorbidities. Data are limited on the relative contributions of cardiovascular versus noncardiovascular diseases to death in individuals with HF in the community. We examined the incidence and predictors of cardiovascular vs. noncardiovascular death in participants with HF in the Framingham Heart Study. Underlying, immediate and contributing causes of death (3 key elements of the World Health Organization classification) were adjudicated by a 3-physician review panel. During 1971-2004, 1025 participants with HF died (499 men, mean [SD] age at death 79 [11] years), including 463 participants with left ventricular ejection fraction (LVEF) data. Cardiovascular disease was the cause of death in 66.1% overall. Stratified by LVEF, cardiovascular deaths occurred in 44.5% and 69.9% of those with preserved and reduced LVEF, respectively. Presence of reduced LVEF increased the risk of cardiovascular death with odds ratios of 3.16 (95%CI 1.73-5.78) in men and 2.39 (95%CI 1.39-4.08) in women. Prior myocardial infarction was associated with increased cardiovascular death in women with HF (odds ratio 1.87, 95%CI; 1.10-3.16), but not in men. The risk of cardiovascular disease death decreased in women (odds ratio post-1980 0.41, 95%CI 0.24-0.69) and men (odds ratio 0.66, 95%CI 0.41-1.07, p=0.095) with HF over time. Infections and kidney disease emerged as key immediate and contributing causes of death, respectively. Individuals with HF in the community often experience cardiovascular death, but noncardiovascular disease also contributes significantly especially among those with preserved LVEF.