National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010.
National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010.
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DOI：
10.1161/circulationaha.113.003668
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发表时间：
2013-12-17
期刊：
影响因子：
37.8
通讯作者：
Krumholz HM
中科院分区：
文献类型：
--
作者：
Chen J;Hsieh AF;Dharmarajan K;Masoudi FA;Krumholz HM
关于急性心肌梗死（AMI）后心力衰竭（HF）的发生率如何随时间变化，以往的研究报告了相互矛盾的结果，关于当代国家趋势的数据很少。我们使用1998-2010年医疗保险付费服务受益人的2，789，943例AMI住院的完整全国样本，使用泊松和生存分析模型评估随后HF住院和死亡率的年度变化。AMI后1年内因HF住院的患者数量从1998年的16.1/100人年适度下降至2010年的14.2/100人年（p<0.001）。调整人口统计学因素后，在研究期间观察到AMI后HF住院率相对下降14.6%（发病风险比0.854，95%置信区间[CI] 0.809-0.901）。1998年，AMI后HF住院后未校正的1年死亡率为44.4%，2004-2005年下降至43.2%，但到2010年又上升至45.5%。在调整人口统计学因素和临床合并症后，从1998年到2007年，这代表了2.4%的相对年下降（风险比[HR] 0.976，95% CI 0.974-0.978），但从2007年到2010年，相对年增加5.1%（HR 1.051，95% CI 1.039-1.064）。在全国医疗保险受益人样本中，AMI后HF住院率从1998年到2010年有所下降，这可能表明AMI管理的改善。相比之下，AMI后HF后的生存率仍然很差，并且从2007年到2010年已经恶化，表明AMI后这种高风险状况的治疗仍然存在挑战。
Previous studies have reported conflicting findings regarding how the incidence of heart failure (HF) following acute myocardial infarction (AMI) has changed over time, and data on contemporary national trends are sparse. Using a complete national sample of 2,789,943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998-2010, we evaluated annual changes in the incidence of subsequent HF hospitalization and mortality using Poisson and survival analysis models. The number of patients hospitalized for HF within 1 year following AMI declined modestly from 16.1 per 100 person-years in 1998 to 14.2 per 100 person years in 2010 (p<0.001). After adjusting for demographic factors, a relative 14.6% decline for HF hospitalizations after AMI was observed over the study period (incidence risk ratio 0.854, 95% confidence interval [CI] 0.809-0.901). Unadjusted 1-year mortality following HF hospitalization after AMI was 44.4% in 1998, which decreased to 43.2% in 2004-2005, but then increased to 45.5% by 2010. After adjusting for demographic factors and clinical comorbidities, this represented a 2.4% relative annual decline (hazard ratio [HR] 0.976, 95% CI 0.974-0.978) from 1998 to 2007, but a 5.1% relative annual increase from 2007 to 2010 (HR 1.051, 95% CI 1.039-1.064). In a national sample of Medicare beneficiaries, HF hospitalization following AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI. In contrast, survival after HF following AMI remains poor, and has worsened from 2007 to 2010, demonstrating that challenges still remain for the treatment of this high-risk condition after AMI.