Improved survival after heart failure: a community-based perspective.
Improved survival after heart failure: a community-based perspective.
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DOI：
10.1161/jaha.113.000053
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发表时间：
2013-05-15
影响因子：
5.4
通讯作者：
Goldberg RJ
中科院分区：
文献类型：
--
作者：
Joffe SW;Webster K;McManus DD;Kiernan MS;Lessard D;Yarzebski J;Darling C;Gore JM;Goldberg RJ
心力衰竭是一种高度流行、病态和昂贵的疾病，长期预后不良。过去20年中使用的循证疗法有望改善结局，但很少有当代研究急性心力衰竭患者的生存趋势。这项基于人群的研究的主要目的是描述急性失代偿性心力衰竭（ADHF）住院患者的短期和长期生存率趋势。次要目的是检查与长期生存率降低相关的患者特征。我们回顾了1995年、2000年、2002年和2004年期间在马萨诸塞州中部所有11个医疗中心住院的9748例ADHF患者的病历。与1995年相比，2004年因ADHF住院的患者更可能是老年人，并且被诊断为患有多种合并症。在此期间，住院期间以及出院后1年、2年和5年的生存率显著提高。五年生存率从1995年的20%上升到2004年的29%。尽管生存率随着时间的推移而显著提高，但老年患者和患有慢性肾脏疾病、慢性阻塞性肺疾病、贫血、低体重指数和低血压的患者的出院后生存率始终低于无这些合并症的患者。在1995年至2004年期间，因ADHF住院的患者年龄越来越大，合并症越来越多。尽管这些患者的生存率有了显著改善，但其长期预后仍然很差，2004年因ADHF住院的患者中，存活超过5年的不到1/3。
Heart failure is a highly prevalent, morbid, and costly disease with a poor long‐term prognosis. Evidence‐based therapies utilized over the past 2 decades hold the promise of improved outcomes, yet few contemporary studies have examined survival trends in patients with acute heart failure. The primary objective of this population‐based study was to describe trends in short‐ and long‐term survival in patients hospitalized with acute decompensated heart failure (ADHF). A secondary objective was to examine patient characteristics associated with decreased long‐term survival. We reviewed the medical records of 9748 patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 1995, 2000, 2002, and 2004. Patients hospitalized with ADHF were more likely to be elderly and to have been diagnosed with multiple comorbidities in 2004 compared with 1995. Over this period, survival was significantly improved in‐hospital, and at 1, 2, and 5 years postdischarge. Five‐year survival rates increased from 20% in 1995 to 29% in 2004. Although survival improved substantially over time, older patients and patients with chronic kidney disease, chronic obstructive pulmonary disease, anemia, low body mass index, and low blood pressures had consistently lower postdischarge survival rates than patients without these comorbidities. Between 1995 and 2004, patients hospitalized with ADHF have become older and increasingly comorbid. Although there has been a significant improvement in survival among these patients, their long‐term prognosis remains poor, as fewer than 1 in 3 patients hospitalized with ADHF in 2004 survived more than 5 years.