Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis.
Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis.
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DOI：
10.1016/j.ijcard.2015.05.180
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发表时间：
2015-10-01
影响因子：
3.5
通讯作者：
Kadam UT
中科院分区：
文献类型：
--
作者：
Rushton CA;Satchithananda DK;Jones PW;Kadam UT
在选定的心力衰竭（HF）人群中，非心血管合并症被认为是独立的预后因素，但尚未综合关于非选定HF以及合并症严重程度和变化如何影响结局的证据。我们确定了主要HF合并症随访研究，以比较非心血管合并症、严重程度和变化对生活质量、全因住院和全因死亡率结果的影响。使用经验证的策略和质量评估（QUIPS工具）筛选文献数据库（1990年1月至2013年5月）。使用随机效应荟萃分析合并主要HF结局的校正风险比，并描述了预后模型中合并症的纳入。有68项主要HF研究涵盖9种非心血管合并症。死亡率（93%）和住院率（16%）的结局大多数为糖尿病（DM）、慢性阻塞性肺疾病（COPD）和肾功能不全（RD），中位随访时间为4年。HF合并症与死亡率之间的校正相关性为DM（HR 1.34; 95% CI 1.2，1.5）、COPD（1.39; 1.2，1.6）和RD（1.52; 1.3，1.7）。合并症的严重程度使中度至重度疾病的死亡率分别增加了78%、42%和80%。每种疾病的住院风险增加了50%。少数研究或预后模型包括合并症变化。非心血管合并症和严重程度显著增加了非选择性HF人群中不良结局的预后风险，但在研究合并症状态随时间的变化方面存在重大差距。证据支持将合并症严重程度纳入新的HF干预措施以改善预后结局的逐步变化。我们综合了非选择性HF中非CVD合并症和严重程度的预后证据。大多数研究集中在死亡率和住院的三种合并症，而没有关于QoL COPD、糖尿病和CKD的研究。非选择性HF严重程度研究中死亡率和住院风险增加很少，但在可用的情况下，风险随疾病严重程度增加。合并症严重程度很重要，但尚未纳入HF预后模型
Non-cardiovascular comorbidities are recognised as independent prognostic factors in selected heart failure (HF) populations, but the evidence on non-selected HF and how comorbid disease severity and change impacts on outcomes has not been synthesised. We identified primary HF comorbidity follow-up studies to compare the impact of non-cardiovascular comorbidity, severity and change on the outcomes of quality of life, all-cause hospital admissions and all-cause mortality. Literature databases (Jan 1990–May 2013) were screened using validated strategies and quality appraisal (QUIPS tool). Adjusted hazard ratios for the main HF outcomes were combined using random effects meta-analysis and inclusion of comorbidity in prognostic models was described. There were 68 primary HF studies covering nine non-cardiovascular comorbidities. Most were on diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and renal dysfunction (RD) for the outcome of mortality (93%) and hospital admissions (16%), median follow-up of 4 years. The adjusted associations between HF comorbidity and mortality were DM (HR 1.34; 95% CI 1.2, 1.5), COPD (1.39; 1.2, 1.6) and RD (1.52; 1.3, 1.7). Comorbidity severity increased mortality from moderate to severe disease by an estimated 78%, 42% and 80% respectively. The risk of hospital admissions increased up to 50% for each disease. Few studies or prognostic models included comorbidity change. Non-cardiovascular comorbidity and severity significantly increases the prognostic risk of poor outcomes in non-selected HF populations but there is a major gap in investigating change in comorbid status over time. The evidence supports a step-change for the inclusion of comorbidity severity in new HF interventions to improve prognostic outcomes. We synthesise the prognosis evidence on non-CVD comorbidity and severity in non-selected HF Most studies focused on three comorbid diseases for mortality and admissions and none for QoL COPD, diabetes and CKD increased mortality and admission risk in non-selected HF Severity studies were few but where available, risk increased with disease severity Comorbidity severity is important but has yet to be included in HF prognostic models