Multimorbidity in patients with heart failure from 11 Asian regions: A prospective cohort study using the ASIAN-HF registry.
Multimorbidity in patients with heart failure from 11 Asian regions: A prospective cohort study using the ASIAN-HF registry.
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DOI：
10.1371/journal.pmed.1002541
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发表时间：
2018-03
期刊：
影响因子：
15.8
通讯作者：
ASIAN-HF authors
中科院分区：
文献类型：
--
作者：
Tromp J;Tay WT;Ouwerkerk W;Teng TK;Yap J;MacDonald MR;Leineweber K;McMurray JJV;Zile MR;Anand IS;Richards AMR;Lam CSP;ASIAN-HF authors
合并症在心力衰竭（HF）患者中很常见，并使治疗和结果复杂化。我们确定了亚洲心衰患者的多发病模式及其与患者生活质量（QoL）和健康结果的关系。我们使用了2012年10月1日至2016年10月6日在亚洲心力衰竭猝死（asia -HF）登记处登记的6480例慢性心力衰竭患者（1204例保留射血分数）的数据。asia - hf登记是一项前瞻性队列研究，患者来自11个亚洲地区（香港、台湾、中国、日本、韩国、印度、马来西亚、泰国、新加坡、印度尼西亚和菲律宾）的门诊和门诊。潜在类别分析用于识别多重发病模式。主要终点被定义为1年内全因死亡率或HF住院率的综合指标。为了评估生活质量的差异，我们使用了堪萨斯城心肌病问卷。我们确定了5个不同的多病组：老年/房颤（AF） （N = 1048；年龄较大，房颤较多），代谢性（N = 1129；肥胖，糖尿病，高血压），年轻（N = 1759；最年轻，低合并症发生率，非缺血性病因），缺血性（N = 1261；缺血性病因）和瘦型糖尿病（N = 1283；糖尿病，高血压，低肥胖患病率，高慢性肾脏疾病患病率）。消瘦型糖尿病组患者的生活质量最差，心衰体征和症状更严重，1年内主要综合转归发生率最高（29%，而年轻组为11%）（p均<0.001）。调整混杂因素（人口统计学、纽约心脏协会分类和药物）后，与年轻组相比，瘦型糖尿病组（风险比[HR] 1.79, 95% CI 1.46-2.22）、老年/AF组（风险比[HR] 1.57, 95% CI 1.26-1.96）、缺血性组（风险比[HR] 1.51, 95% CI 1.22-1.88）和代谢组（风险比[HR] 1.28, 95% CI 1.02-1.60）的主要综合结局发生率更高。潜在的限制包括场地选择和参与偏见。在亚洲HF患者中，合并症自然地聚集在5种不同的模式中，每种模式对患者的生活质量和健康结果都有不同的影响。这些数据强调了研究心衰多发病的重要性，以及对心衰多发病患者进行表型分析需要更全面的方法。Carolyn Lam及其同事利用亚洲hf登记处的数据，研究了11个亚洲国家心衰患者的多病模式。心衰患者中多病（≥2种合并症）的患病率正在增加。多病可阻碍生存并使治疗复杂化。然而，以前的研究是孤立地调查单一的合并症。使用潜在类别分析，我们在亚洲11个地区的6480例心力衰竭患者（1204例心力衰竭和保留射血分数）的前瞻性队列研究中确定了心力衰竭患者的多发病模式。我们确定了5个多发病组：老年/房颤（老年，房颤较多），代谢性（肥胖，糖尿病，高血压），年轻（年轻，合并症患病率低），缺血性（缺血性病因）和瘦型糖尿病（糖尿病，肥胖患病率低）。多病组在亚洲有不同的地理分布，并与心脏结构和功能的变化有关。总体而言，瘦型糖尿病组与死亡率或因心力衰竭住院的综合结果有最强的关联。我们的研究结果表明，多病在心力衰竭患者中非常普遍，并且与独特的地理分布和不良后果有关。综上所述，我们的数据强调了心力衰竭患者多重发病的重要性，并呼吁对心力衰竭和多重发病患者进行更全面的表型分析。
Comorbidities are common in patients with heart failure (HF) and complicate treatment and outcomes. We identified patterns of multimorbidity in Asian patients with HF and their association with patients’ quality of life (QoL) and health outcomes. We used data on 6,480 patients with chronic HF (1,204 with preserved ejection fraction) enrolled between 1 October 2012 and 6 October 2016 in the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry. The ASIAN-HF registry is a prospective cohort study, with patients prospectively enrolled from in- and outpatient clinics from 11 Asian regions (Hong Kong, Taiwan, China, Japan, Korea, India, Malaysia, Thailand, Singapore, Indonesia, and Philippines). Latent class analysis was used to identify patterns of multimorbidity. The primary outcome was defined as a composite of all-cause mortality or HF hospitalization within 1 year. To assess differences in QoL, we used the Kansas City Cardiomyopathy Questionnaire. We identified 5 distinct multimorbidity groups: elderly/atrial fibrillation (AF) (N = 1,048; oldest, more AF), metabolic (N = 1,129; obesity, diabetes, hypertension), young (N = 1,759; youngest, low comorbidity rates, non-ischemic etiology), ischemic (N = 1,261; ischemic etiology), and lean diabetic (N = 1,283; diabetic, hypertensive, low prevalence of obesity, high prevalence of chronic kidney disease). Patients in the lean diabetic group had the worst QoL, more severe signs and symptoms of HF, and the highest rate of the primary combined outcome within 1 year (29% versus 11% in the young group) (p for all <0.001). Adjusting for confounders (demographics, New York Heart Association class, and medication) the lean diabetic (hazard ratio [HR] 1.79, 95% CI 1.46–2.22), elderly/AF (HR 1.57, 95% CI 1.26–1.96), ischemic (HR 1.51, 95% CI 1.22–1.88), and metabolic (HR 1.28, 95% CI 1.02–1.60) groups had higher rates of the primary combined outcome compared to the young group. Potential limitations include site selection and participation bias. Among Asian patients with HF, comorbidities naturally clustered in 5 distinct patterns, each differentially impacting patients’ QoL and health outcomes. These data underscore the importance of studying multimorbidity in HF and the need for more comprehensive approaches in phenotyping patients with HF and multimorbidity. ClinicalTrials.gov NCT01633398 Using data from the ASIAN-HF Registry, Carolyn Lam and colleagues examine multimorbidity patterns in patients with heart failure from 11 Asian countries The prevalence of multimorbidity (≥2 comorbidities) is increasing among patients with heart failure. Multimorbidity can impede survival and complicate treatment. Yet, previous studies have investigated single comorbidities in isolation. Using latent class analysis, we identified patterns of multimorbidity among patients with heart failure from 11 regions in Asia in a prospective cohort study of 6,480 patients with heart failure (1,204 with heart failure and a preserved ejection fraction). We identified 5 multimorbidity groups: elderly/atrial fibrillation (old, more atrial fibrillation), metabolic (obese, diabetic, hypertensive), young (younger, low prevalence of comorbidities), ischemic (ischemic etiology), and lean diabetic (diabetic, low prevalence of obesity). Multimorbidity groups had distinct geographic distributions across Asia and were associated with changes in cardiac structure and function. Overall, the lean diabetic group had the strongest association with a combined outcome of mortality or hospitalization for heart failure. Our findings suggest that multimorbidity is highly prevalent in patients with heart failure and is associated with a distinct geographic distribution and adverse outcomes. Combined, our data underscore the importance of multimorbidity in patients with heart failure and call for more comprehensive approaches in phenotyping patients with heart failure and multimorbidity.
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影响因子：
4.8
作者：
Luo N;Teng TK;Tay WT;Anand IS;Kraus WE;Liew HB;Ling LH;O'Connor CM;Piña IL;Richards AM;Shimizu W;Whellan DJ;Yap J;Lam CSP;Mentz RJ;ASIAN-HF;HF-ACTION investigators
通讯作者：
HF-ACTION investigators
影响因子：
5.9
作者：
Comin-Colet, Josep;Garin, Olatz;Elosua, Roberto
通讯作者：
Elosua, Roberto
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
DOI：
10.1001/jama.2015.17346
发表时间：
2016-01-05
期刊：
JAMA
影响因子：
--
作者：
Kitzman DW;Brubaker P;Morgan T;Haykowsky M;Hundley G;Kraus WE;Eggebeen J;Nicklas BJ
通讯作者：
Nicklas BJ
影响因子：
3.7
作者：
Kao DP;Wagner BD;Robertson AD;Bristow MR;Lowes BD
通讯作者：
Lowes BD