Prior Heart Failure Hospitalization and Outcomes in Patients with Heart Failure with Preserved and Reduced Ejection Fraction.
Prior Heart Failure Hospitalization and Outcomes in Patients with Heart Failure with Preserved and Reduced Ejection Fraction.
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DOI：
10.1016/j.amjmed.2019.06.040
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发表时间：
2020-01
影响因子：
5.9
通讯作者：
Ahmed, Ali
中科院分区：
文献类型：
--
作者：
Malik, Awais;Gill, Gauravpal S.;Lodhi, Fahad K.;Tummala, Lakshmi S.;Singh, Steven N.;Morgan, Charity J.;Allman, Richard M.;Fonarow, Gregg C.;Ahmed, Ali
先前因心力衰竭住院与门诊心力衰竭患者预后不良相关。对于住院心力衰竭患者的这种关联，以及它是否随射血分数而变化，我们所知较少。在医疗保险相关的optime - hf登记的25345例住院患者中，22491例已知心力衰竭，其中7648例和9558例心力衰竭，分别保持（≥50%）和降低（≤40%）射血分数（HFpEF和HFrEF）。总体而言，在指数住院前6个月内，HFpEF和HFrEF患者分别有927例和1862例心力衰竭住院。使用先前心力衰竭住院的倾向评分，我们分别收集了924对和1844对HFpEF和HFrEF患者的两个匹配队列，每个队列平衡了58个基线特征。使用Cox回归模型估计6年随访期间结局的风险比（hr）和95%置信区间（ci）。在1848例匹配的HFpEF患者中，全因死亡率、全因再入院和心力衰竭再入院的hr （95% ci）分别为1.35 （1.21-1.50,p<0.001）、1.34 （1.21-1.47,p<0.001）和1.90 （1.67-2.16,p<0.001）。3688例匹配的HFrEF患者的hr （95% ci）分别为1.17 （1.09 -1.26,p<0.001）、1.32 （1.23 -1.41,p<0.001）和1.48 （1.37 -1.61,p<0.001）。在心力衰竭住院患者中，既往心力衰竭住院与HFpEF和HFrEF中较高的死亡率和再入院风险相关。HFpEF患者的死亡和心力衰竭再入院的相对风险似乎高于HFrEF患者。
A prior hospitalization due to heart failure is associated with poor outcomes in ambulatory patients with heart failure. Less is known about this association in hospitalized patients with heart failure and whether it varies by ejection fraction. Of the 25,345 hospitalized patients in Medicare-linked OPTIMIZE-HF registry, 22,491 had known heart failure, of whom 7648 and 9558 had heart failure with preserved (≥50%) and reduced (≤40%) ejection fraction (HFpEF and HFrEF), respectively. Overall, 927 and 1862 patients with HFpEF and HFrEF had heart failure hospitalizations during six months before the index hospitalization, respectively. Using propensity scores for prior heart failure hospitalization, we assembled two matched cohorts of 924 pairs and 1844 pairs of patients with HFpEF and HFrEF, respectively, each balanced for 58 baseline characteristics. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes during six years of follow-up. Among 1848 matched patients with HFpEF, HRs (95% CIs) for all-cause mortality, all-cause readmission and heart failure readmission were 1.35 (1.21–1.50; p<0.001), 1.34 (1.21–1.47; p<0.001) and 1.90 (1.67–2.16; p<0.001), respectively. Respective HRs (95% CIs) in 3688 matched patients with HFrEF were 1.17 (1.09 –1.26; p<0.001), 1.32 (1.23 –1.41; p<0.001), and 1.48 (1.37 –1.61; p<0.001). Among hospitalized patients with heart failure, a prior heart failure hospitalization is associated with higher risks of mortality and readmission in both HFpEF and HFrEF. The relative risks of death and heart failure readmission appear to be higher in HFpEF than in HFrEF.
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