Predictors of incident heart failure in a large insured population: a one million person-year follow-up study.
Predictors of incident heart failure in a large insured population: a one million person-year follow-up study.
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DOI：
10.1161/circheartfailure.110.938175
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发表时间：
2010-11
期刊：
影响因子：
--
通讯作者：
Wilson PW
中科院分区：
文献类型：
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作者：
Goyal A;Norton CR;Thomas TN;Davis RL;Butler J;Ashok V;Zhao L;Vaccarino V;Wilson PW
关于心力衰竭（HF）的发病率和预测因素的研究通常仅限于老年人或仅确定住院病例。我们在2000年至2005年期间的任何时间，对359947名在Kaiser Permanente Georgia投保的女性和男性（年龄≥18岁）进行了门诊或住院诊断的新HF的发病率和预测。受试者在基线时无HF，并通过ICD-9代码（1例住院或2例门诊HF就诊）确定了事件HF。我们建立了多变量Cox模型来评估前因因素（冠心病、高血压、糖尿病、心房颤动和瓣膜性心脏病）与心衰的关系。针对不同性别和门诊或住院新诊断的心衰建立了不同的模型。在1015794人年的随访期间，有4001例HF病例（50%为女性，48%为<65岁的受试者）。男性的心衰发生率高于女性（4.24 vs 3.68 / 1000人-年），但在整个研究期间，男性和女性的心衰发生率均保持稳定。这一人群中三分之二的心衰病例发生在门诊患者中。这5个前因因素和年龄在门诊和住院患者以及两性中对心衰事件都有很好的区分（所有模型的c> 0.85）。无论是在门诊还是住院，常见的可改变的危险因素都能准确地区分女性和男性患心衰的风险。在我们的参保人群中，大约三分之二的新HF病例是在门诊诊断出来的；需要更多的研究来确定这些患者的特征及其预后。
Studies on the incidence and predictors of heart failure (HF) are often restricted to elderly persons or identify only inpatient cases. We determined the incidence and predictors of new HF diagnosed in either outpatient or inpatient settings, among 359 947 women and men (age ≥18 years) insured by Kaiser Permanente Georgia at any time during calendar years 2000 to 2005. Subjects were free of HF at baseline, and incident HF was identified with ICD-9 codes (1 inpatient or 2 outpatient HF visits). We developed multivariable Cox models to assess the association of antecedent factors (coronary heart disease, hypertension, diabetes mellitus, atrial fibrillation, and valvular heart disease) with incident HF. Separate models were created for each sex and for newly diagnosed HF in outpatient or inpatient settings. There were 4001 incident HF cases (50% women and 48% in subjects <65 years old), during 1 015 794 person-years of follow-up. The incidence rate of HF was greater in men than in women (4.24 versus 3.68 per 1000 person-years) but was stable across the study interval in both sexes. Two thirds of incident HF cases from this population occurred in outpatients. These 5 antecedent factors and age yielded excellent discrimination for incident HF in both outpatients and inpatients and in both sexes (C >0.85 in all models). Common modifiable risk factors accurately discriminate women and men at risk for HF diagnosed in either outpatient or inpatient settings. Approximately two thirds of new HF cases in our insured population were diagnosed in outpatients; more research is needed to characterize these subjects and their prognosis.