Characteristics, interventions and outcomes of patients with valvular heart disease hospitalised in China: a cross-sectional study.
Characteristics, interventions and outcomes of patients with valvular heart disease hospitalised in China: a cross-sectional study.
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DOI：
10.1136/bmjopen-2021-052946
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发表时间：
2021-11-03
期刊：
影响因子：
2.9
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Huang X;Dhruva SS;Yuan X;Bai X;Lu Y;Yan X;Liu J;Li W;Hu D;Ji R;Gao M;Miao F;Li J;Ge J;Krumholz HM;Li J
对中国心脏瓣膜病的当代特点和治疗知之甚少。本研究旨在了解中国地区VHD患者的临床特点、病因、类型、干预措施及住院转归。我们采用两阶段随机抽样设计，创建了2015年在中国住院的具有全国代表性的VHD患者样本，包括轻、中、重度成人VHD患者。我们从包括超声心动图报告在内的医疗记录中提取关于患者特征、病因、VHD的类型和严重程度、干预措施和住院结果的数据。我们权衡了我们的发现，以估计具有全国代表性的住院人数。我们进行了多变量Logistic回归分析，以确定与瓣膜干预相关的因素。2015年，在188家随机抽样的医院中，38841名VHD患者住院，占中国住院VHD患者的662 384人。我们对9363例患者进行了超声心动图检查，平均年龄68.7岁(95%可信区间42.2~95.2)，男性46.8%(95%可信区间45.8%~47.8%)。退行性病变为主要病因(33.3%，95%CI为32.3%~34.3%)，风湿病因为VHD患者最常见的病因(37.4%，95%CI为35.9%~38.8%)。风湿因素也是中、重度VHD患者最常见的病因(分别为27.3%，95%CI 25.6%~29.0%和33.6%，95%CI 31.9%~35.2%)。最常见的VHD是二尖瓣返流(79.1%，95%CI 78.2%~79.9%)，其次是三尖瓣返流(77.4%，95%CI 76.5%~78.2%)。在最初诊断为严重VHD的患者中，35.6%(95%可信区间33.1%至38.1%)在住院期间接受了瓣膜介入治疗。在手术风险较高的患者中，介入的可能性显著降低。在中国住院的VHD患者中，病因以退行性变为主；在中、重度VHD患者中，风湿性疾病是最常见的病因。应促进有针对性的战略和政策，以解决退行性VHD问题。严重的VHD患者可能得不到足够的治疗，特别是那些具有高手术风险的患者。
Little is known about contemporary characteristics and management of valvular heart disease (VHD) in China. This study aimed to examine the clinical characteristics, aetiology and type of VHD, interventions and in-hospital outcomes of patients with VHD hospitalised in China. We used a two-stage random sampling design to create a nationally representative sample of patients with VHD hospitalised in 2015 in China and included adult patients with mild, moderate or severe VHD. We abstracted data from medical records, including echocardiogram reports, on patient characteristics, aetiology, type and severity of VHD, interventions and in-hospital outcomes. We weighted our findings to estimate nationally representative hospitalisations. We performed multivariable logistic regression analysis to identify factors associated with valve intervention. In 2015, 38 841 patients with VHD were hospitalised in 188 randomly sampled hospitals, representing 662 384 inpatients with VHD in China. We sampled 9363 patients, mean age 68.7 years (95% CI 42.2 to 95.2) and 46.8% (95% CI 45.8% to 47.8%) male, with an echocardiogram. Degenerative origin was the predominant aetiology overall (33.3%, 95% CI 32.3% to 34.3%), while rheumatic origin was the most frequent aetiology among patients with VHD as the primary diagnosis (37.4%, 95% CI 35.9% to 38.8%). Rheumatic origin was also the most common aetiology among patients with moderate or severe VHD (27.3%, 95% CI 25.6% to 29.0% and 33.6%, 95% CI 31.9% to 35.2%, respectively). The most common VHD was mitral regurgitation (79.1%, 95% CI 78.2% to 79.9%), followed by tricuspid regurgitation (77.4%, 95% CI 76.5% to 78.2%). Among patients with a primary diagnosis of severe VHD who were admitted to facilities capable of valve intervention, 35.6% (95% CI 33.1% to 38.1%) underwent valve intervention during the hospitalisation. The likelihood of intervention decreased significantly among patients with higher operative risk. Among patients with VHD hospitalised in China, the predominant aetiology was degenerative in origin; among patients with moderate or severe VHD, rheumatic origin was the most common aetiology. Targeted strategies and policies should be promoted to address degenerative VHD. Patients with severe VHD may be undertreated, particularly those with high operative risk.
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影响因子：
39.3
作者：
Iung, B;Baron, G;Vahanian, A
通讯作者：
Vahanian, A
DOI：
10.1016/s0140-6736(18)30473-2
发表时间：
2018-03-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
Dziadzko V;Clavel MA;Dziadzko M;Medina-Inojosa JR;Michelena H;Maalouf J;Nkomo V;Thapa P;Enriquez-Sarano M
通讯作者：
Enriquez-Sarano M
1990-2016年中国心血管疾病负担：2016年全球疾病负担研究结果
影响因子：
24
作者：
Liu, Shiwei;Li, Yichong;Zhou, Maigeng
通讯作者：
Zhou, Maigeng
影响因子：
24
作者：
Bach, David S.;Awais, Mazen;Kohnstamm, Sarah
通讯作者：
Kohnstamm, Sarah
影响因子：
168.9
作者：
Nkomo, Vuyisile T.;Gardin, Julius M.;Enriquez-Sarano, Maurice
通讯作者：
Enriquez-Sarano, Maurice