Prevalence and Prognostic Significance of Polyvascular Disease in Patients Hospitalized With Acute Decompensated Heart Failure: The ARIC Study.
Prevalence and Prognostic Significance of Polyvascular Disease in Patients Hospitalized With Acute Decompensated Heart Failure: The ARIC Study.
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急性失代偿性心力衰竭住院患者多血管疾病的患病率及预后意义：社区动脉粥样硬化风险研究（ARIC研究）
DOI：
10.1016/j.cardfail.2022.01.002
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发表时间：
2022-08
影响因子：
6
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中科院分区：
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多血管疾病与死亡率增加和生活质量下降有关。射血分数降低与保留的心力衰竭住院患者（分别为HFrEF与HFpEF）的患病率或相关结局是否不同尚不确定。社区动脉粥样硬化风险（ARIC）研究从2005年至2014年对急性失代偿性心力衰竭（ADHF）进行了医院监测。多血管疾病（≥2个动脉床中的共存疾病）从流行的冠状动脉疾病、外周动脉疾病和脑血管疾病中确定。分别分析HFpEF和HFrEF与多血管疾病相关的死亡风险，并对潜在混杂因素进行调整。所有分析均按抽样概率的倒数加权。在24，937例加权（5，460例未加权）ADHF住院治疗中（52%为女性，32%为黑人，平均年龄75岁），22%的HFrEF患者和17%的HFpEF患者普遍存在多血管。对于HFrEF（29%-32%-38%; P趋势=0.0006）和HFpEF（26%-32%-37%; P趋势<0.0001）患者，1年死亡风险随0、1和≥2个动脉床受累顺序增加。校正后，多血管疾病与HFrEF患者的死亡风险增加26%（HR=1.26; 95% CI：1.07-1.50）和HFpEF患者的死亡风险增加29%（HR =1.29; 95% CI：1.03-1.62）相关，与HF类型无相互作用（P-相互作用= 0.9）。因ADHF和并存的多血管疾病住院的患者死亡风险增加，与HF类型无关。临床应注意多血管疾病，实施二级预防策略，以改善这一高危人群的预后。已知多血管疾病与心肌梗死、中风或心血管死亡相关，是生活质量下降的主要风险因素。本研究旨在评估急性失代偿性心力衰竭（ADHF）住院患者多血管疾病与死亡率之间的关系，并了解射血分数是否不同。无论心力衰竭类型如何，因ADHF和并存的多血管疾病住院的患者死亡风险增加，这意味着需要增加针对多血管疾病的临床关注，沿着实施二级预防策略以改善预后。急性HF和并存的多血管疾病住院患者面临死亡风险增加，无论HF类型如何。
Polyvascular disease is associated with increased mortality and decreased quality of life. Whether its prevalence or associated outcomes differ for patients hospitalized with heart failure with reduced versus preserved ejection fraction (HFrEF vs. HFpEF, respectively) is uncertain. The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of acute decompensated heart failure (ADHF) from 2005–2014. Polyvascular disease (coexisting disease in ≥2 arterial beds) was identified from prevalent coronary artery disease, peripheral artery disease, and cerebrovascular disease. Mortality risks associated with polyvascular disease were analyzed separately for HFpEF and HFrEF, with adjustment for potential confounders. All analyses were weighted by the inverse of the sampling probability. Out of 24,937 weighted (5,460 unweighted) ADHF hospitalizations (52% female, 32% Black, mean age 75 years), polyvascular was prevalent in 22% with HFrEF and 17% with HFpEF. One-year mortality risks increased sequentially with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend<0.0001). After adjustments, polyvascular disease was associated with a 26% higher mortality hazard for patients with HFrEF (HR=1.26; 95% CI: 1.07–1.50) and a 29% higher hazard for patients with HFpEF (HR =1.29; 95% CI: 1.03–1.62), with no interaction by HF type (P-interaction = 0.9). Patients hospitalized with ADHF and coexisting polyvascular disease have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward polyvascular disease, with implementation of secondary prevention strategies to improve the prognosis of this high-risk population. Polyvascular disease is known to be associated with myocardial infarction, stroke or cardiovascular death and is a major risk factor for decreased quality of life. This study sought to evaluate the relationship between polyvascular disease and mortality in patients hospitalized with acute decompensated heart failure (ADHF), and to understand whether the associations differ based on ejection fraction. Patients hospitalized with ADHF and coexisting polyvascular disease had an increased risk of death, irrespective of heart failure type, implying the need for increased clinical attention directed towards polyvascular disease, along with implementation of secondary prevention strategies to improve prognosis. Patients hospitalized with acute HF and coexisting polyvascular disease face an increased risk of death, irrespective of HF type.