Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort.
Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort.
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DOI：
10.1371/journal.pmed.1002501
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发表时间：
2018-03
期刊：
影响因子：
15.8
通讯作者：
Gale CP
中科院分区：
文献类型：
--
作者：
Hall M;Dondo TB;Yan AT;Mamas MA;Timmis AD;Deanfield JE;Jernberg T;Hemingway H;Fox KAA;Gale CP
对于急性心肌梗死（AMI）患者的多药治疗的规模和影响的了解有限。因此，本研究旨在确定AMI后多发病与长期生存的相关程度。这项国家观察性研究纳入了来自心肌缺血国家审计项目（英格兰和威尔士）的693，388例患者（中位年龄70.7岁，452，896例[65.5%]男性），这些患者在2003年1月1日至2013年6月30日期间因AMI入院。有412，809（59.5%）例AMI患者入院时患有多项心肌梗死，即，具有以下长期健康状况中的至少一种：糖尿病、慢性阻塞性肺病或哮喘、心力衰竭、肾衰竭、脑血管疾病、外周血管疾病或高血压。心力衰竭、肾衰竭或脑血管疾病患者的结局最差（每100人-年分别有39.5例[95% CI 39.0-40.0]、38.2例[27.7-26.8]和26.6例[25.2-26.4]死亡）。潜在类别分析显示3个多发病表型簇：（1）高多发病类别，伴有心力衰竭、外周血管疾病和高血压，（2）中多发病类别，伴有外周血管疾病和高血压，和（3）低多发病类别。与2类和3类患者相比，1类患者接受药物治疗的可能性较小（包括阿司匹林，分别为83.8%与87.3%和87.2%; β受体阻滞剂，分别为74.0%与80.9%和81.4%;他汀类药物，分别为80.6%与85.9%和85.2%）。灵活参数生存模型表明，在8.4年随访期内，与3类患者相比，1类和2类患者的死亡风险分别增加2.4倍（95% CI 2.3-2.5）和1.5倍（95% CI 1.4-1.5），预期寿命分别减少2.89年和1.52年。由于缺乏可用的病因特异性死亡率数据，该研究仅限于全因死亡率。然而，我们通过提供AMI后预期寿命的损失，与一般年龄、性别和年龄匹配的人群进行比较，分离出疾病特异性与死亡率的相关性。急性心肌梗死患者中多发病是常见的，并赋予了累积的死亡风险增加。三个多发病表型集群与预期寿命的损失显着相关，并应作为伴随治疗目标，以改善心血管结局。ClinicalTrials.gov NCT 03037255。Marlous Hall和他的同事使用潜在类别分析研究了急性心肌梗死患者的多发病率和生存率之间的关系。近几十年来，心脏病发作（急性心肌梗死）后的生存率有所提高。人口正在老龄化，有更多的患者患有多种长期健康状况（多发性硬化症），寿命更长。以前的研究已经研究了个体长期健康状况与心脏病发作后生存率之间的关系，但对多种疾病的模式以及这种多发病模式如何与患者的结局相关知之甚少。在2003年至2013年期间，英格兰和威尔士共有693，388名心脏病发作的患者被纳入研究。59.5%的患者在心脏病发作时至少有以下一种长期健康状况：糖尿病、慢性阻塞性肺病或哮喘、心力衰竭、肾衰竭、脑血管疾病（中风）、外周血管疾病或高血压。有3种常见的多发病患者组：（1）心脏病发作时多发病率较高的患者，这些患者往往患有心力衰竭以及外周血管疾病和高血压，（2）心脏病发作时多发病率中等的患者，这些患者往往患有外周血管疾病和高血压，（3）合并症较少的患者。与几乎没有合并症的患者相比，高水平和中等水平多发病的患者平均预期寿命分别减少2.9年和1.5年。这项研究表明，许多心脏病发作的患者都有多Morphology，而那些具有高和中等水平多Morphology的患者可能会经历预期寿命的显着减少。虽然这项研究包括7种最常见于心脏病发作患者的疾病，但可能还有其他疾病，包括痴呆症和癌症，需要在这种情况下进行调查。未来的研究应该集中在为多Morphine患者群体制定治疗指南，以改善多Morphine心脏病发作患者的预后。
There is limited knowledge of the scale and impact of multimorbidity for patients who have had an acute myocardial infarction (AMI). Therefore, this study aimed to determine the extent to which multimorbidity is associated with long-term survival following AMI. This national observational study included 693,388 patients (median age 70.7 years, 452,896 [65.5%] male) from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013. There were 412,809 (59.5%) patients with multimorbidity at the time of admission with AMI, i.e., having at least 1 of the following long-term health conditions: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease, peripheral vascular disease, or hypertension. Those with heart failure, renal failure, or cerebrovascular disease had the worst outcomes (39.5 [95% CI 39.0–40.0], 38.2 [27.7–26.8], and 26.6 [25.2–26.4] deaths per 100 person-years, respectively). Latent class analysis revealed 3 multimorbidity phenotype clusters: (1) a high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension, (2) a medium multimorbidity class, with peripheral vascular disease and hypertension, and (3) a low multimorbidity class. Patients in class 1 were less likely to receive pharmacological therapies compared with class 2 and 3 patients (including aspirin, 83.8% versus 87.3% and 87.2%, respectively; β-blockers, 74.0% versus 80.9% and 81.4%; and statins, 80.6% versus 85.9% and 85.2%). Flexible parametric survival modelling indicated that patients in class 1 and class 2 had a 2.4-fold (95% CI 2.3–2.5) and 1.5-fold (95% CI 1.4–1.5) increased risk of death and a loss in life expectancy of 2.89 and 1.52 years, respectively, compared with those in class 3 over the 8.4-year follow-up period. The study was limited to all-cause mortality due to the lack of available cause-specific mortality data. However, we isolated the disease-specific association with mortality by providing the loss in life expectancy following AMI according to multimorbidity phenotype cluster compared with the general age-, sex-, and year-matched population. Multimorbidity among patients with AMI was common, and conferred an accumulative increased risk of death. Three multimorbidity phenotype clusters that were significantly associated with loss in life expectancy were identified and should be a concomitant treatment target to improve cardiovascular outcomes. ClinicalTrials.gov NCT03037255. Using latent class analysis, Marlous Hall and colleagues examine the associations between mulitmorbidity and survival in patients with acute myocardial infarction. Survival following a heart attack (acute myocardial infarction) has improved over recent decades. The population is ageing, and there are more patients living longer with multiple long-term health conditions (multimorbidity). Previous studies have looked at the associations between individual long-term health conditions and survival following a heart attack, but little is known about patterns of multiple conditions and how such multimorbidity patterns may be associated with patients’ outcomes. A total of 693,388 patients who had a heart attack between 2003 and 2013 across England and Wales were included in the study. 59.5% of patients had at least 1 of the following long-term health conditions at the time of their heart attack: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease (stroke), peripheral vascular disease, or hypertension. There were 3 common multimorbidity patient groups: (1) patients with high multimorbidity at the time of their heart attack, who tended to have heart failure as well as peripheral vascular disease and hypertension, (2) patients with medium multimorbidity at the time of their heart attack, who tended to have peripheral vascular disease and hypertension, and (3) patients with few co-morbidities. Patients who had high and medium levels of multimorbidity had average reduced life expectancies of 2.9 and 1.5 years, respectively, compared with patients who had few co-morbidities. This study shows that many patients with a heart attack have multimorbidity, and that those with high and medium levels of multimorbidity are likely to experience a significant reduction in years of life expectancy. Whilst this study included 7 conditions most commonly occurring in patients who have a heart attack, there may be other conditions including dementia and cancer that require investigation in this context. Future research should focus on developing treatment guidelines for the multimorbidity patient groups identified to improve outcomes for heart attack patients with multimorbidity.
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DOI：
10.1136/heartjnl-2015-308850
发表时间：
2016-05-15
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Asaria M;Walker S;Palmer S;Gale CP;Shah AD;Abrams KR;Crowther M;Manca A;Timmis A;Hemingway H;Sculpher M
通讯作者：
Sculpher M
影响因子：
--
作者：
Collerton J;Jagger C;Yadegarfar ME;Davies K;Parker SG;Robinson L;Kirkwood TB
通讯作者：
Kirkwood TB
影响因子：
120.7
作者：
Fox, Keith A. A.;Steg, Philippe Gabriel;Gore, Joel M.
通讯作者：
Gore, Joel M.
影响因子：
5.9
作者：
Gili, Miguel;Sala, Jose;Sanchez, Gabriel
通讯作者：
Sanchez, Gabriel
DOI：
10.1093/ehjqcco/qcv011
发表时间：
2015-11-01
影响因子：
5.2
作者：
Hall, Marlous;Alabas, Oras A.;Gale, Chris P.
通讯作者：
Gale, Chris P.