Cardiovascular vs. non-cardiovascular deaths after heart failure hospitalization in young, older, and very old patients.
Cardiovascular vs. non-cardiovascular deaths after heart failure hospitalization in young, older, and very old patients.
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心力衰竭（HF）患者住院后的长期预后可能因年龄和左心室射血分数（LVEF）的不同而有很大差异。我们旨在根据年龄评估心血管死亡（CVD）和非心血管死亡的相对比率，以及在更新的LVEF分类系统下这些比率如何不同。
连续登记的住院心力衰竭患者（N = 3558；女性占39.7%，平均年龄73.9 ± 13.3岁）中位随访时间为2年（四分位间距，0.8 - 3.1年）。根据年龄[年轻（<65岁）、老年（65 - 84岁）和高龄（≥85岁）]以及LVEF分类[射血分数保留的心力衰竭（HFpEF；LVEF ≥50%）和非HFpEF（LVEF <50%）]对心血管疾病和非心血管疾病进行评估。不良临床事件由一个中心委员会独立判定。总体而言，1505例（42.3%）为HFpEF[年轻：n = 182（12.1%），老年：n = 894（59.4%），高龄：n = 429（28.5%）]，2053例（57.7%）为非HFpEF[年轻：n = 575（28.0%），老年：n = 1159（56.5%），高龄：n = 319（15.5%）]。在随访期间，所有年龄组中非HFpEF的全因死亡粗发病率均高于HFpEF（非HFpEF与HFpEF相比，年轻：10.4%与5.5%，对数秩检验P = 0.10；老年：26.6%与20.9%，对数秩检验P = 0.002；高龄：36.7%与31.7%，对数秩检验P = 0.043）。在非HFpEF中，心血管疾病占所有死亡的一半以上（年轻65.0%，老年64.2%，高龄55.6%），而在HFpEF中，心血管疾病所占比例不到一半（年轻50.0%，老年41.2%，高龄38.2%）。心力衰竭再入院与非HFpEF患者随后的全因死亡相关[风险比（HR）：1.72，95%置信区间（CI）：1.41 - 2.09，P < 0.001]，但在HFpEF中无关（HR：1.12，95%CI：0.87 - 1.43，P = 0.39）。
在两种LVEF类别中，非心血管疾病的发生概率都随着年龄的增长而增加，但在HFpEF类别中更高。研究结果表明，仅减轻心血管相关结局可能不足以治疗老年人群的心力衰竭，特别是HFpEF类别。
The long‐term outcome in patients with heart failure (HF) after hospitalization may vary substantially depending on their age and left ventricular ejection fraction (LVEF). We aimed to assess the relative rates of cardiovascular death (CVD) and non‐CVD based on the age and how the rates differ under the updated LVEF classification system. Consecutively registered hospitalized patients with HF (N = 3558; 39.7% women with a mean age of 73.9 ± 13.3 years) were followed for a median of 2 (interquartile range, 0.8–3.1) years. The CVDs and non‐CVDs were evaluated based on age [young (<65 years), older (65–84 years), and very old (≥85 years)] and LVEF classification [HF with preserved EF (HFpEF; LVEF ≥50%) and non‐HFpEF (LVEF <50%)]. The adverse clinical events were adjudicated independently by a central committee. Overall, 1505 (42.3%) had HFpEF [young: n = 182 (12.1%), older: n = 894 (59.4%), very old: n = 429 (28.5%)], and 2053 (57.7%) had non‐HFpEF [young: n = 575 (28.0%), older: n = 1159 (56.5%), very old: n = 319 (15.5%)]. During the follow‐up, the crude incidence of all‐cause death was higher in non‐HFpEF than in HFpEF across all age groups (non‐HFpEF vs. HFpEF, young: 10.4% vs. 5.5%, log‐rank P = 0.10; older: 26.6% vs. 20.9%, log‐rank P = 0.002; very old: 36.7% vs. 31.7%, log‐rank P = 0.043). CVDs accounted for more than half of all deaths in non‐HFpEF (young 65.0%, older 64.2%, and very old 55.6%), whereas the proportion of CVDs remained less than half in HFpEF (young 50.0%, older 41.2%, very old 38.2%). HF readmission was associated with subsequent all‐cause death in non‐HFpEF [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.41–2.09, P < 0.001], but not in HFpEF (HR: 1.12, 95% CI: 0.87–1.43, P = 0.39). The probability of a non‐CVD increases in both LVEF categories with advancing age, but that it is greater in the HFpEF category. The findings indicate that mitigating CV‐related outcomes alone may be insufficient for treating HF in older population, particularly in the HFpEF category.
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影响因子：
24
作者：
Gorodeski EZ;Goyal P;Hummel SL;Krishnaswami A;Goodlin SJ;Hart LL;Forman DE;Wenger NK;Kirkpatrick JN;Alexander KP;Geriatric Cardiology Section Leadership Council, American College of Cardiology
通讯作者：
Geriatric Cardiology Section Leadership Council, American College of Cardiology
影响因子：
24
作者：
Driggin, Elissa;Cohen, Laura P.;Gallagher, Dympna;Karmally, Wahida;Maddox, Thomas;Hummel, Scott L.;Carbone, Salvatore;Maurer, Mathew S.
通讯作者：
Maurer, Mathew S.
影响因子：
18.2
作者：
Metra, Marco;Mentz, Robert J.;O'Connor, Christopher M.
通讯作者：
O'Connor, Christopher M.
影响因子：
158.5
作者：
Solomon, S. D.;McMurray, J. J. V.;Lefkowitz, M. P.
通讯作者：
Lefkowitz, M. P.
影响因子：
13
作者：
Loungani, Rahul S.;Teerlink, John R.;Felker, G. Michael
通讯作者：
Felker, G. Michael