Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure.
Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure.
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DOI：
10.1136/heartjnl-2017-312539
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Cubbon RM
中科院分区：
文献类型：
--
作者：
Witte KK;Patel PA;Walker AMN;Schechter CB;Drozd M;Sengupta A;Byrom R;Kearney LC;Sapsford RJ;Kearney MT;Cubbon RM
探讨慢性心力衰竭（CHF）患者的社会经济剥夺与不良结局之间的关系。我们前瞻性观察了2006年至2014年间在英国四家医院招募的1802名CHF且左心室射血分数（LVEF）≤ 45%的患者。我们评估了由英国多重痴呆指数（IMD）定义的剥夺与以下因素之间的相关性：模式特异性死亡率（平均随访4年）;模式特异性住院;以及累积住院时间（1年后）。居住在最贫困和最贫困的五分之一地理区域的患者之间的平均IMD评分差异为45分。去甲肾上腺素与年龄、性别和合并症相关，但与CHF症状、LVEF或处方药物治疗无关。IMD评分与年龄-性别校正的全因死亡率风险（IMD评分每增加10个单位风险增加6%; 95% CI 2%至10%; P=0.004）和非心血管死亡率风险（IMD评分每增加10个单位风险增加9%; 95% CI 3%至16%; P=0.003）相关，但与心血管死亡率无关。在最贫困的患者中，全因而非心力衰竭的住院治疗也更常见。总体而言，患者在1年随访期间累计住院3.3天，IMD评分与年龄-性别调整的累计住院时间相关（IMD评分每增加10个单位，住院时间增加4%; 95% CI 3%至6%; P<0.0005）。CHF患者的社会经济剥夺与由于非心血管事件过多而导致的死亡和住院风险增加有关。
To characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF). We prospectively observed 1802 patients with CHF and left ventricular ejection fraction (LVEF) ≤45%, recruited in four UK hospitals between 2006 and 2014. We assessed the association between deprivation defined by the UK Index of Multiple Deprivation (IMD) and: mode-specific mortality (mean follow-up 4 years); mode-specific hospitalisation; and the cumulative duration of hospitalisation (after 1 year). A 45-point difference in mean IMD score was noted between patients residing in the least and most deprived quintiles of geographical regions. Deprivation was associated with age, sex and comorbidity, but not CHF symptoms, LVEF or prescribed drug therapy. IMD score was associated with the risk of age-sex adjusted all-cause mortality (6% higher risk per 10-unit increase in IMD score; 95% CI 2% to 10%; P=0.004), and non-cardiovascular mortality (9% higher risk per 10-unit increase in IMD score; 95% CI 3% to 16%; P=0.003), but not cardiovascular mortality. All-cause, but not heart failure-specific, hospitalisation was also more common in the most deprived patients. Overall, patients spent a cumulative 3.3 days in hospital during 1 year of follow-up, with IMD score being associated with the age-sex adjusted cumulative duration of hospitalisations (4% increase in duration per 10-unit increase in IMD score; 95% CI 3% to 6%; P<0.0005). Socioeconomic deprivation in people with CHF is linked to increased risk of death and hospitalisation due to an excess of non-cardiovascular events.
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影响因子：
9.7
作者：
Cubbon, Richard M.;Gale, Christopher P.;Kearney, Mark T.
通讯作者：
Kearney, Mark T.
影响因子：
105.7
作者：
SMITH, GD;BARTLEY, M;BLANE, D
通讯作者：
BLANE, D
影响因子：
3.7
作者：
Heslop CL;Miller GE;Hill JS
通讯作者：
Hill JS
影响因子：
5.9
作者：
Shah, Sunil M.;Carey, Iain M.;Cook, Derek G.
通讯作者：
Cook, Derek G.
影响因子：
18.2
作者：
Stewart, S;Jenkins, A;McMurray, JJJV
通讯作者：
McMurray, JJJV