National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998-2008
National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998-2008
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DOI：
10.1001/jama.2011.1474
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发表时间：
2011-10-19
影响因子：
120.7
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Chen, Jersey;Normand, Sharon-Lise T.;Krumholz, Harlan M.
目前尚不清楚近期缺血性心脏病及其危险因素的下降是否伴随着心力衰竭住院率和死亡率的下降。目的探讨美国HF住院率和1年死亡率的变化，包括全国和各州或各地区。设计、环境和参与者来自美国和波多黎各的急性护理医院，1998年至2008年间住院的55 097 390名按服务收费的医疗保险受益人，主要出院诊断代码为心衰。主要结局指标患者人口统计学和合并症、心衰住院率和1年死亡率的变化。结果经年龄、性别、种族调整后的HF住院率由1998年的2845 / 10万人-年下降到2008年的2007 / 10万人-年（P < 0.001），相对下降29.5%。在研究期间，所有种族和性别类别的年龄调整心衰住院率均有所下降。在所有种族性别类别中，黑人男性的下降率最低（每10万人年4142至3201人），在调整年龄后仍然存在（发病率比，0.81;95% CI, 0.79-0.84）。心力衰竭住院率下降的速度在16个州明显快于全国平均水平，在3个州明显慢于全国平均水平。经风险调整后的1年死亡率从1999年的31.7%下降到2008年的29.6% (P < 0.001)，相对下降6.6%。1年死亡率在4个州显著下降，但在5个州上升。结论：1998年至2008年，心力衰竭患者住院率显著下降，但黑人患者住院率较低。在过去十年中，总体1年死亡率略有下降，但仍然很高。各州心衰住院率和1年死亡率的变化不均衡。《美国医学协会杂志》上。2011年;306 (15): 1669 - 1678
Context It is not known whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure (HF) hospitalization and mortality.Objective To examine changes in HF hospitalization rate and 1-year mortality rate in the United States, nationally and by state or territory.Design, Setting, and Participants From acute care hospitals in the United States and Puerto Rico, 55 097 390 fee-for-service Medicare beneficiaries hospitalized between 1998 and 2008 with a principal discharge diagnosis code for HF.Main Outcome Measures Changes in patient demographics and comorbidities, HF hospitalization rates, and 1-year mortality rates.Results The HF hospitalization rate adjusted for age, sex, and race declined from 2845 per 100 000 person-years in 1998 to 2007 per 100 000 person-years in 2008 (P < .001), a relative decline of 29.5%. Age-adjusted HF hospitalization rates declined over the study period for all race-sex categories. Black men had the lowest rate of decline (4142 to 3201 per 100 000 person-years) among all race-sex categories, which persisted after adjusting for age (incidence rate ratio, 0.81; 95% CI, 0.79-0.84). Heart failure hospitalization rates declined significantly faster than the national mean in 16 states and significantly slower in 3 states. Risk-adjusted 1-year mortality decreased from 31.7% in 1999 to 29.6% in 2008 (P < .001), a relative decline of 6.6%. One-year mortality rates declined significantly in 4 states but increased in 5 states.Conclusions The overall HF hospitalization rate declined substantially from 1998 to 2008 but at a lower rate for black men. The overall 1-year mortality rate declined slightly over the past decade but remains high. Changes in HF hospitalization and 1-year mortality rates were uneven across states. JAMA. 2011;306(15):1669-1678