Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure - A report from the OPTIMIZE-HF registry
Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure - A report from the OPTIMIZE-HF registry
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DOI：
10.1016/j.jacc.2007.04.064
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发表时间：
2007-08-21
影响因子：
24
通讯作者：
Young, James B.
中科院分区：
文献类型：
--
作者：
Fonarow, Gregg C.;Stough, Wendy Gattis;Young, James B.
目的：我们试图评估保留和降低收缩功能心力衰竭（HF）患者的特征、治疗和结局。背景：伴有收缩功能保留的心力衰竭（PSF）是一种常见的疾病，但目前还没有得到很好的理解。方法：对optime - hf （Organized Program to Initiate Lifesaving Treatment in hospital With心力衰竭住院患者）注册表进行分析，比较20,118例左室收缩功能不全（LVSD）患者和21,149例PSF患者（左室射血分数[EF1 >= 40%）。在预先指定的10%的患者样本中进行了60至90天的随访。对定义为EF bb0 50%的PSF患者进行分析以进行比较。结果PSF患者（EF >= 40%）多为老年、女性、白种人，且多为非缺血性病因。虽然两组的住院时间相同，但PSF患者的住院死亡率风险较低（EF >= 40%） （2.9% vs. 3.9%; p < 0.0001）。在出院后60- 90天的随访中，PSF患者（EF >= 40%）与LVSD患者的死亡率（9.5% vs. 9.8%, p = 0.459）和再住院率（29.2% vs. 29.9%, p = 0.591）相似。结果与定义为EF - 50%的PSF患者相当。在风险和倾向调整模型中，出院时使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或β -阻滞剂与PSF患者60- 90天死亡率和再住院率之间没有显著关系。来自OPTIMIZE-HF登记的数据显示HF合并PSF的患病率很高，这些患者与HF合并LVSD患者具有相似的出院后死亡风险和同样高的再住院率。尽管对患者和卫生保健系统造成了负担，但缺乏关于心衰和PSF患者有效管理策略的数据。
Objectives We sought to evaluate the characteristics, treatments, and outcomes of patients with preserved and reduced systolic function heart failure (HF). Background Heart failure with preserved systolic function (PSF) is common but not well understood.Methods This analysis of the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry compared 20,118 patients with left ventricular systolic dysfunction (LVSD) and 21,149 patients with PSF (left ventricular ejection fraction [EF1 >= 40%). Sixty-to 90-day follow-up was obtained in a pre-specified 10% sample of patients. Analyses of patients with PSF defined as EF > 50% were also performed for comparison.Results Patients with PSF (EF >= 40%) were more likely to be older, female, and Caucasian and to have a nonischernic etiology. Although length of hospital stay was the same in both groups, risk of in-hospital mortality was lower in patients with PSF (EF >= 40%) (2.9% vs. 3.9%; p < 0.0001). During 60-to 90-day post-discharge follow-up, patients with PSF (EF >= 40%) had a similar mortality risk (9.5% vs. 9.8%; p = 0.459) and rehospitalization rates (29.2% vs. 29.9%; p = 0.591) compared with patients with LVSD. Findings were comparable with those with PSF defined as EF > 50%. In a risk- and propensity-adjusted model, there were no significant relationships between discharge use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or beta-blocker and 60- to 90-day mortality and rehospitalization rates in patients with PSF.Conclusions Data from the OPTIMIZE-HF registry reveal a high prevalence of HF with PSF, and these patients have a similar post-discharge mortality risk and equally high rates of rehospitalization as patients with HF and LVSD. Despite the burden to patients and health care systems, data are lacking on effective management strategies for patients with HF and PSF.