Trends in prevalence and outcome of heart failure with preserved ejection fraction
Trends in prevalence and outcome of heart failure with preserved ejection fraction
复制标题
DOI：
10.1056/nejmoa052256
复制
发表时间：
2006-07-20
影响因子：
158.5
通讯作者：
Redfield, Margaret M.
中科院分区：
文献类型：
--
作者：
Owan, Theophilus E.;Hodge, David O.;Redfield, Margaret M.
背景：射血分数保持不变的心力衰竭患病率可能会随着人口统计学以及心力衰竭危险因素的流行和治疗的改变而改变。保留射血分数的心力衰竭患病率的改变可能有助于心力衰竭自然病史的改变。我们进行了一项研究，以确定在同一机构的患者中，15年来射血分数保留的心力衰竭患病率的长期趋势。方法：我们研究了明尼苏达州奥姆斯特县梅奥诊所医院从1987年到2001年连续住院的所有失代偿性心力衰竭患者。我们将患者分为保留射血分数或减少射血分数。这些患者还被归类为社区患者(奥姆斯特县居民)或转诊患者。结果：在15年的时间里，共有6076名心力衰竭患者出院；其中4596名患者(76%)的射血分数数据可用。在这些患者中，53%的患者射血分数降低，47%的患者射血分数保持不变。被诊断为心力衰竭并保留射血分数的患者的比例随着时间的推移而增加，社区患者中的比例明显高于转诊患者(55%对45%)。随着时间的推移，心力衰竭患者中高血压、房颤和糖尿病的患病率显著增加。射血分数保留的患者的存活率略好(调整后的死亡风险比为0.96；P=0.01)。随着时间的推移，射血分数降低的患者的存活率有所提高，但射血分数保留的患者则没有。结论：在15年的时间里，射血分数保留的心力衰竭的患病率增加，而这种疾病的死亡率保持不变。这些趋势突显了这个日益严重的公共卫生问题的重要性。
Background: The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved ejection fraction among patients at a single institution over a 15-year period.Methods: We studied all consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, from 1987 through 2001. We classified patients as having either preserved or reduced ejection fraction. The patients were also classified as community patients (Olmsted County residents) or referral patients. Secular trends in the type of heart failure, associated cardiovascular disease, and survival were defined.Results: A total of 6076 patients with heart failure were discharged over the 15-year period; data on ejection fraction were available for 4596 of these patients (76 percent). Of these, 53 percent had a reduced ejection fraction and 47 percent had a preserved ejection fraction. The proportion of patients with the diagnosis of heart failure with preserved ejection fraction increased over time and was significantly higher among community patients than among referral patients (55 percent vs. 45 percent). The prevalence rates of hypertension, atrial fibrillation, and diabetes among patients with heart failure increased significantly over time. Survival was slightly better among patients with preserved ejection fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival improved over time for those with reduced ejection fraction but not for those with preserved ejection fraction.Conclusions: The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.