Outcome of congestive heart failure in elderly persons: Influence of left ventricular systolic function - The cardiovascular health study
Outcome of congestive heart failure in elderly persons: Influence of left ventricular systolic function - The cardiovascular health study
复制标题
DOI：
10.7326/0003-4819-137-8-200210150-00006
复制
发表时间：
2002-10-15
影响因子：
39.2
通讯作者：
Manolio, TA
中科院分区：
文献类型：
--
作者：
Gottdiener, JS;McClelland, RL;Manolio, TA
背景：大多数充血性心力衰竭患者都是老年人，许多患有充血性心力衰竭的老年人左心室收缩功能正常。目的：评估老年人左心室收缩功能与充血性心力衰竭结局之间的关系。设计：基于人群的冠心病和脑卒中的纵向研究。地点：美国四个地点：北卡罗来纳州福赛斯县；加利福尼亚州萨克拉门托县；宾夕法尼亚州阿勒格尼县；参与者：5888 名年龄至少 65 岁且从社区招募的人。测量：总死亡率以及心血管发病率和死亡率。结果：在 5532 名参与者中，269 名 (4.9%) 患有充血性心力衰竭。其中，63%的人左心室功能正常，15%的人左心室功能处于临界状态，22%的人左心室功能明显受损。参考组的死亡率为每 1000 人年 25 人死亡（基线时无充血性心力衰竭且左心室功能正常）；患有充血性心力衰竭和左心室收缩功能受损的参与者每 1000 人年中有 154 人死亡；患有充血性心力衰竭且收缩功能正常或临界的参与者中，每 1000 人年分别有 87 人和 115 人死亡；左心室功能受损但无充血性心力衰竭的患者每 1000 人年有 89 人死亡。虽然收缩功能正常的人死于充血性心力衰竭的风险低于收缩功能正常的人，但更多的死亡与收缩功能正常的人有关，因为更多的心力衰竭患者属于这一类。结论：社区居住的老年人，特别是左心室功能受损的老年人，死于充血性心力衰竭的风险很大。然而，收缩功能正常的人死于心力衰竭的情况更多，因为患有心力衰竭的老年人的左心室功能通常比受损的左心室功能更正常。
Background: Most persons with congestive heart failure are elderly, and many elderly persons with congestive heart failure have normal left ventricular systolic function.Objective: To evaluate the relationship between left ventricular systolic function and outcome of congestive heart failure in elderly persons.Design: Population-based longitudinal study of coronary heart disease and stroke. Setting: Four U.S. sites: Forsyth County, North Carolina; Sacramento County, California; Allegheny County, Pennsylvania; and Washington County, Maryland.Participants: 5888 persons who were at least 65 years of age and were recruited from the community.Measurements: Total mortality and cardiovascular morbidity and mortality.Results: Of 5532 participants, 269 (4.9%) had congestive heart failure. Among these, left ventricular function was normal in 63%, borderline decreased in 15%, and overtly impaired in 22%. The mortality rate was 25 deaths per 1000 person-years in the reference group (no congestive heart failure and normal left ventricular function at baseline); 154 deaths per 1000 person-years in participants with congestive heart failure and impaired left ventricular systolic function; 87 and 115 deaths per 1000 person-years in participants with congestive heart failure and normal or borderline systolic function, respectively; and 89 deaths per 1000 person-years in persons with impaired left ventricular function but no congestive heart failure. Although the risk for death from congestive heart failure was lower in persons with normal systolic function than in those with impaired function, more deaths were associated with normal systolic function because more persons with heart failure fall into this category.Conclusions: Community-dwelling elderly persons, especially those with impaired left ventricular function, have a substantial risk for death from congestive heart failure. However, more deaths occur from heart failure in persons with normal systolic function because left ventricular function is more often normal than impaired in elderly persons with heart failure.