Changing incidence and survival for heart failure in a well-defined older population, 1970-1974 and 1990 1994
Changing incidence and survival for heart failure in a well-defined older population, 1970-1974 and 1990 1994
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DOI：
10.1161/circulationaha.104.492033
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发表时间：
2006-02-14
期刊：
影响因子：
37.8
通讯作者：
Getchell, W
中科院分区：
文献类型：
--
作者：
Barker, WH;Mullooly, JP;Getchell, W
背景：近年来，心衰（HF）死亡率、住院率和患病率在老年人中呈上升趋势。目前尚不清楚这是否反映了发病率或生存率的增加。方法和结果：我们进行了一项回顾性队列研究，比较1970年至1974年和1990年至1994年的HF患者，这些患者年龄在bb0 = 65岁，属于一个大的、定义明确的、有完整医疗记录可用于研究的人群。使用Framingham临床标准，我们确定了各自时期的心衰事件病例。比较了年龄特异性和年龄调整的发病率、死亡率和生存率。Cox比例风险模型用于评估合并症和药物与生存率的关系。在1970年至1974年和1990年至1994年期间，分别有38800人和127419人年，确定了387人和1555例确诊病例。经年龄调整后，发病率增加14%（95%可信区间2% - 28%）。老年人和男性的发病率增加趋势更大。基于5年随访和年龄及合并症调整，男性死亡率风险降低33% (95% CI 14% - 48%)，女性死亡率风险降低24% （95% CI -1% - 43%）。结论：20世纪70年代至90年代，老年人群中心衰的流行增加与发病率增加和生存率提高有关，这两种影响在男性中更大。
Background-An epidemic increase in heart failure (HF) mortality, hospitalization, and prevalence rates has been observed among older persons in recent years. It is unclear whether this reflects an increase in incidence or survival.Methods and Results-We conducted a retrospective cohort study comparing HF in 1970 to 1974 and 1990 to 1994 among persons >= 65 years old belonging to a large, well-defined population with complete medical records available for research. Using Framingham clinical criteria, we identified incident cases of HF in the respective periods. Age-specific and age-adjusted incidence, mortality, and survival rates were compared. Cox proportional-hazards models were used to assess association of comorbidities and medications with survival. During 38 800 and 127 419 person-years for 1970 to 1974 and 1990 to 1994, respectively, 387 and 1555 confirmed incident cases were identified. When adjusted for age, incidence increased by 14% (95% CI 2% to 28%). Increased incidence tended to be greater for older persons and for men. Based on 5-year follow-up and adjustment for age and comorbidities, the mortality hazards decreased 33% ( 95% CI 14% to 48%) among men and 24% (95% CI -1% to 43%) among women.Conclusions-The epidemic increase in HF among the older population between the 1970s and 1990s is associated with increased incidence and improved survival, with both of these effects being greater in men.