Twenty year trends (1975-1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction - A community-wide perspective
Twenty year trends (1975-1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction - A community-wide perspective
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DOI：
10.1016/s0735-1097(99)00390-3
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发表时间：
1999-11-01
影响因子：
24
通讯作者：
Gore, JM
中科院分区：
文献类型：
--
作者：
Spencer, FA;Meyer, TE;Gore, JM
目的：从人口的角度来描述，最近的和暂时的（1975-1995）心力衰竭（HF）并发急性心肌梗死（AMI）的发病率、院内和出院后病死率的趋势。背景：从全社区的角度描述HF并发AMI的发病率和病死率的数据非常有限。我们回顾了马萨诸塞州伍斯特市6,798名居民的医疗记录，这些居民在1975年至1995年的10个年度中患有经证实的MI，并且以前没有HF住院。AMI患者住院期间发生HF的比例在1975-1978年（38%）和1993-1995年（33%）之间下降（p < 0.001）。在控制了潜在的混杂因素后，发生HF的风险随着时间的推移逐渐下降，尽管幅度不大。1975-1978年（33%）和1993-1995年（18%）之间，AMI合并HF患者的住院病死率下降了约46%（p < 0.001）。在调整潜在的混杂预后因素后，观察到住院生存率的改善趋势。一个标准杆出院后死亡率为HF的医院幸存者没有改变超过20年的研究期间，即使在控制了额外的预后characteristics.CONCLUSIONS：这项社区范围的研究结果表明，令人鼓舞的发病率和住院死亡率下降与HF并发AMI。鉴于HF临床综合征的严重程度，需要继续努力预防HF。鉴于AMI后症状性左心室功能不全患者的长期预后缺乏改善，需要努力进行二级预防，以确定和改善对这些患者的治疗。(C)1999年由美国心脏病学会。
OBJECTIVES: To describe from a population-based perspective, recent and temporal (1975-1995) trends in the incidence, in-hospital and postdischarge case-fatality rates of heart failure (HF) complicating acute myocardial infarction (AMI).BACKGROUND: Extremely limited data are available describing the incidence and case-fatality rates associated with HF complicating AMI from a community-wide perspective.METHODS: The medical records of 6,798 residents of the Worcester, Massachusetts metropolitan area with validated MI and without previous HF hospitalized in 10 annual periods between 1975 and 1995 were reviewed.RESULTS: The proportion of AMI patients developing HF during hospitalization declined between 1975-1978 (38%) and 1993-1995 (33%) (p < 0.001). After controlling for potentially confounding factors, the risk of developing HF declined progressively, albeit modestly, over time. in-hospital case-fatality rates of patients with AMI complicated by HF declined by approximately 46% between 1975-1978 (33%) and 1993-1995 (18%) (p < 0.001). Improving trends in hospital survival were observed after adjusting for potentially confounding prognostic factors. The one-par post-discharge mortality rate for hospital survivors of HF did not change over the 20-year period under study, even after controlling for additional prognostic characteristics.CONCLUSIONS: The results of this community-wide study suggest encouraging declines in the incidence and hospital death rates associated with HF complicating AMI. Continued efforts need to be directed towards the prevention of HF given the magnitude of this clinical syndrome. Efforts of secondary prevention are needed to identify and improve the treatment of patients with symptomatic left ventricular dysfunction following AMI given the lack of improvement in the long term prognosis of these patients. (C) 1999 by the American College of Cardiology.