Advanced Heart Failure Characteristics and Outcomes in Commercially Insured U.S. Adults.
Advanced Heart Failure Characteristics and Outcomes in Commercially Insured U.S. Adults.
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有商业保险的美国成年人的晚期心力衰竭特征和结果。
DOI：
10.1016/j.jchf.2023.06.029
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Dunlay,ShannonM
中科院分区：
文献类型：
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作者：
Subramaniam,Anna;vanHouten,Holly;Redfield,MargaretM;Sangaralingham,LindseyR;Savitz,SamuelT;Glasgow,Amy;Schulte,PhillipJ;LeMond,LisaM;Dunlay,ShannonM
背景由于在人群中广泛应用复杂的高级心力衰竭定义的挑战，晚期心力衰竭患者的特征和结果一直没有明确的定义。目的在这项研究中，作者试图将经过验证的高级心力衰竭算法应用于一个大型的美国行政索赔数据库，并描述高级心力衰竭治疗的人群和使用。晚期心力衰竭的算法需要在12个月内因心力衰竭住院2次，外加1次晚期心力衰竭的额外征象。使用COX比例风险模型检验基线特征与死亡率的关系。结果在60,197名确诊的晚期心力衰竭患者中，平均年龄73岁，男性占51.5%，非西班牙裔白人占64.3%，亚裔占1.9%，黑人占21.2%，西班牙裔占8.2%。晚期心力衰竭患者的中位生存期为2.0年(IQR：0.4~5.5年)。观察了年龄、性别和种族/民族在死亡率和高级治疗使用方面的差异。在年龄较大、男性、非西班牙裔白人和来自农村地区的患者中，调整后的死亡率更高(P<；0.05)。高级疗法在老年患者和女性中的使用较少(P<；0.05)。与白人患者相比，黑人患者更有可能接受左心辅助装置的治疗(P=0.010)，但接受心脏移植的可能性较低(P=0.034)。结论在美国晚期心力衰竭患者中，年龄、性别和种族/民族在预后和先进治疗方法的使用方面存在差异。
BackgroundThe characteristics and outcomes of patients with advanced heart failure (HF) have been poorly defined due to challenges in applying the complex advanced HF definition broadly to populations.ObjectivesIn this study, the authors sought to apply a validated advanced HF algorithm to a large U.S. administrative claims database and describe the population and use of advanced HF therapies.MethodsThis study included adults with advanced HF identified in the OptumLabs Data Warehouse from 2009 to 2019. The algorithm for advanced HF required 2 hospitalizations for HF plus 1 additional sign of advanced HF in a 12-month period. The association of baseline characteristics with mortality was examined with the use of Cox proportional hazards models. Associations of patient characteristics with advanced therapies were estimated with the use of cause-specific Cox proportional hazard models.ResultsIn 60,197 patients identified with advanced HF, the mean age was 73 years, 51.5% were men, and 64.3% were non-Hispanic White, 1.9% Asian, 21.2% Black, and 8.2% Hispanic. The median survival with advanced HF was 2.0 years (IQR: 0.4-5.5 years). Differences in mortality and use of advanced therapies by age, sex, and race/ethnicity were observed. Adjusted mortality was higher in patients who were older, male, non-Hispanic White, and from rural areas (P <0.05 for all). Advanced therapies were used less in older patients and women (P <0.05 for both). Black patients were more likely to be treated with a left ventricular assist device (P =0.010) but less likely to receive a heart transplant compared with White patients (P =0.034).ConclusionsIn U.S. adults with advanced HF, variation in outcomes and use of advanced therapies exist by age, sex, and race/ethnicity.