Trends in comorbidity, disability, and polypharmacy in heart failure.
Trends in comorbidity, disability, and polypharmacy in heart failure.
复制标题
DOI：
10.1016/j.amjmed.2010.08.017
复制
发表时间：
2011-02
影响因子：
5.9
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Wong, Catherine Y.;Chaudhry, Sarwat I.;Desai, Mayur M.;Krumholz, Harlan M.
共病、残疾和多药联用通常使心力衰竭患者的护理复杂化。这些因素可以改变对治疗的生物学反应，降低患者遵守建议的能力，并改变患者对治疗和结果的偏好。然而，对心力衰竭患者的复杂性缺乏全面的了解。我们的目标是评估具有全国代表性的、以社区为基础的心力衰竭人群在人口统计学、共病、身体功能和药物使用方面的趋势。利用国民健康和营养检查调查的数据，我们分析了3个调查期(1988-1994年、1999-2002年、2003-2008年)的趋势。我们发现1395名参与者有自我报告的心力衰竭(1988-1994年581人，1999-2002年280人，2003-2008年534人)。心力衰竭患者≥80岁的比例从1988年至1994年的13.3%增加到2003年至2008年的22.4%(P<；.01)。心力衰竭患者合并5种以上慢性疾病的比例从42.1%上升到58.0%(P<；.01)。平均处方药数量从4.1张增加到6.4张(P<；.01)。残疾患病率没有增加，但在所有年份都很严重。在过去的20年里，心力衰竭患者的表型发生了很大的变化。最值得注意的是，较新的患者中高龄患者的比例较高，合并疾病和药物治疗的数量显著增加。功能障碍很普遍，尽管它并没有改变。这些变化表明，需要新的研究和实践战略，以适应这一人群日益增长的复杂性。
Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population. Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988–1994, 1999–2002, 2003–2008). We identified 1395 participants with self-reported heart failure (n = 581 in 1988–1994, n = 280 in 1999–2002, n = 534 in 2003–2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988–1994 to 22.4% in 2003–2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years. The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.
登录
查看更多内容
影响因子：
5
作者：
Desai, MM;Bruce, ML;Druss, BG
通讯作者：
Druss, BG
影响因子：
5.9
作者：
Lee, DS;Mamdani, MM;Tu, JV
通讯作者：
Tu, JV
影响因子：
120.7
作者：
Boyd, CM;Darer, J;Wu, AW
通讯作者：
Wu, AW
影响因子：
4.8
作者：
Baker, DW;Einstadter, D;Cebul, RD
通讯作者：
Cebul, RD
影响因子：
39.2
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
通讯作者：
Van Lente, Frederick