Recurrent hospitalizations are associated with increased mortality across the ejection fraction range in heart failure.
Recurrent hospitalizations are associated with increased mortality across the ejection fraction range in heart failure.
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DOI：
10.1002/ehf2.12792
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发表时间：
2020-10
影响因子：
3.8
通讯作者：
Ukkonen H
中科院分区：
文献类型：
--
作者：
Huusko J;Tuominen S;Studer R;Corda S;Proudfoot C;Lassenius M;Ukkonen H
因心力衰竭 (HF) 住院且左心室射血分数 (LVEF) 保留的患者比例正在上升，但尚无批准的治疗方法，部分原因是对这种特定 HF 表型的表征不完整。为了更好地定义芬兰 HF 表型的特征，对一个随访时间为 12 年的大型队列进行了分析。根据 LVEF 测量值和 N 末端 B 型利钠肽原 (NT-proBNP) 水平对 2005 年至 2017 年间在芬兰西南部医院区诊断的患者进行分层。在这项回顾性登记研究中，既往诊断的心力衰竭患者定义如下：射血分数降低的患者（HFrEF；LVEF≤40%；n=4042）、射血分数中等的患者（HFmrEF；LVEF>40-50%和NT-proBNP≥125pg/mL；n=1468）和射血分数保留的患者（HFpEF；1468）。 LVEF > 50% 且 NT-proBNP ≥ 125 pg/mL；n = 3122），并分别随访 15 022、4962 和 10 097 患者年。分析了心血管 (CV) 住院和死亡率、预选协变量对住院和死亡率的影响，以及 LVEF 下降至 HFrEF 表型的 HFpEF 和 HFmrEF 患者的比例。所有数据均从电子患者登记册中提取。 HFrEF 患者的再住院时间略早于 HFpEF/HFmrEF 患者，但第二次、第三次和第四次再住院率在亚组之间没有差异。女性和更好的肾功能与 HFmrEF 和 HFrEF 的再住院减少相关，而 HFpEF 的趋势不显着。每增加一次住院治疗，死亡风险就会增加两倍，心血管死亡风险就会增加 2.2 至 2.3 倍。 HFpEF 患者的全因死亡率较高。尽管 HFpEF 患者的 CV 死亡率较低，但它与所有患者组中指数 NT-proBNP 浓度升高相关。在索引日期后的 10 年内，26% 的 HFmrEF 患者和 10% 的 HFpEF 患者进展为 HFrEF 表型。这些发现表明，就 LVEF 表型而言，就住院频率增加而言，疾病进展以及住院次数增加与死亡率之间的关系是相似的。这些数据强调了有效治疗的重要性，可以减少住院治疗，并表明监测 NT-proBNP 水平在 HFpEF 患者管理中的作用尤其重要。
The proportion of patients hospitalized for heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is rising, but no approved treatment exists, in part owing to incomplete characterization of this particular HF phenotype. In order to better define the characteristics of HF phenotypes in Finland, a large cohort with 12 years' follow‐up time was analysed. Patients diagnosed between 2005 and 2017 at the Hospital District of Southwest Finland were stratified according to LVEF measure and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels. For this retrospective registry study, previously diagnosed HF patients were defined as follows: patients with reduced ejection fraction (HFrEF; LVEF ≤ 40%; n = 4042), mid‐range ejection fraction (HFmrEF; LVEF > 40–50% and NT‐proBNP ≥ 125 pg/mL; n = 1468), and preserved ejection fraction (HFpEF; LVEF > 50% and NT‐proBNP ≥ 125 pg/mL; n = 3122) and followed up for 15 022, 4962, and 10 097 patient‐years, respectively. Cardiovascular (CV) hospitalization and mortality, influence of pre‐selected covariates on hospitalization and mortality, and the proportion of HFpEF and HFmrEF patients with a drop in LVEF to HFrEF phenotype were analysed. All data were extracted from the electronic patient register. HFrEF patients were rehospitalized slightly earlier than HFpEF/HFmrEF patients, but the second, third, and fourth rehospitalization rates did not differ between the subgroups. Female gender and better kidney function were associated with reduced rehospitalizations in HFmrEF and HFrEF, with a non‐significant trend in HFpEF. Each additional hospitalization was associated with a two‐fold increased risk of death and 2.2‐ to 2.3‐fold increased risk of CV death. All‐cause mortality was higher in patients with HFpEF. Although CV mortality was less frequent in HFpEF patients, it was associated with increased NT‐proBNP concentrations at index in all patient groups. During the 10 years following the index date, 26% of HFmrEF patients and 10% of HFpEF patients progressed to an HFrEF phenotype. These findings suggest that disease progression, in terms of increased frequency of hospitalizations, and the relationship between increased number of hospitalizations and mortality are similar by LVEF phenotypes. These data highlight the importance of effective treatments that can reduce hospitalizations and suggest a role for monitoring NT‐proBNP levels in the management of HFpEF patients in particular.
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影响因子：
158.5
作者：
Solomon, S. D.;McMurray, J. J. V.;Lefkowitz, M. P.
通讯作者：
Lefkowitz, M. P.
影响因子：
37.8
作者：
Yancy, Clyde W.;Jessup, Mariell;Westlake, Cheryl
通讯作者：
Westlake, Cheryl
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
DOI：
10.1161/circheartfailure.111.966366
发表时间：
2012-11
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Dunlay SM;Roger VL;Weston SA;Jiang R;Redfield MM
通讯作者：
Redfield MM
影响因子：
14
作者：
Aune, E.;Brown, A.;Whalley, G. A.
通讯作者：
Whalley, G. A.