Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction
Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction
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DOI：
10.1016/j.jchf.2018.03.006
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发表时间：
2018-08-01
影响因子：
13
通讯作者：
Vasan, Ramachandran S.
中科院分区：
文献类型：
--
作者：
Tsao, Connie W.;Lyass, Asya;Vasan, Ramachandran S.
目的 本研究旨在确定社区中与心力衰竭 (HF) 及其亚型（射血分数降低的心力衰竭 [HFrEF] 和射血分数保留的心率 [HFpEF]）相关的发病率和死亡率的时间趋势。 背景 心血管疾病危险因素患病率的重大变化和治疗的进步可能影响了 HF 的发病率和死亡率。 方法 在 FHS（弗雷明汉心脏研究）和 CHS（心血管健康研究）中，对于在年龄 >= 60 岁且无心衰的参与者（n = 15,217；60% 为女性；2,524 例心衰病例；115,703 人年随访）中，我们估计了 1990 年至 1999 年和 2000 年至 2009 年 HF、HFrEF 和 HFpEF 的调整后发病率比率。我们比较了与几十年内和十年间的 HFrEF 与 HFpEF。结果 在这 2 个十年中，HF 发病率比率相似 (p = 0.13)。 HFrEF 的发生率比率下降 (p = 0.0029)，而 HFpEF 的发生率比率上升 (p < 0.001)。尽管男性 HFrEF 发病率下降幅度大于女性，但每十年男性 HFrEF 发病率均高于女性 (p < 0.001)。随着时间的推移，男性和女性的 HFpEF 发病率均显着增加（分别为 p < 0.001 和 p = 0.02）。在 HF 随访期间，1,701 人死亡（67.4%；HFrEF，n = 557 [33%]；HFpEF，n = 474 [29%]）。几十年间 HF 亚型之间或十年内 HFrEF 和 HFpEF 之间的死亡率（总体、心血管疾病和非心血管疾病）没有显着差异。 结论 在 1990 年至 2009 年的几个美国社区样本中，我们观察到 HFrEF 发病率下降和 HFpEF 发病率上升的不同趋势，但总体 HF 发病率稳定，死亡风险较高。我们的研究结果强调需要阐明导致这些观察结果的因素。 (C) 2018 年，美国心脏病学会基金会。
OBJECTIVES This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community.BACKGROUND Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality.METHODS In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were >= 60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades.RESULTS Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade.CONCLUSIONS In several U.S. community-based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations. (C) 2018 by the American College of Cardiology Foundation.