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Abstract：
BACKGROUND: The burden of amyloidosis among hospitalized patients is increasing over time. However, amyloidosis remains an underdiagnosed cause of heart failure (HF) hospitalization among older adults.
OBJECTIVE: We investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF.
METHODS: All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes.
RESULTS: Of 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80).
CONCLUSIONS: In patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.
OBJECTIVE: We investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF.
METHODS: All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes.
RESULTS: Of 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80).
CONCLUSIONS: In patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.
摘要：
背景：住院患者的淀粉样变性负担随着时间的推移而增加。然而,淀粉样变性仍然是老年人心力衰竭（HF）住院的未被诊断的原因。
目的：我们调查了住院心力衰竭患者中淀粉样变性的患病率和预后意义。
方法：在2010年1月1日至2015年8月31日期间，在全国再入院数据库中确定的所有主要诊断为HF的住院治疗均分为有和没有淀粉样变性的继发性诊断。然后在入院年份以3:1的方式将患有淀粉样变性的HF住院与没有淀粉样变性的HF住院进行匹配。排放季度，年龄,性别,和Charlson合并症指数。主要结果是住院死亡率和30天再入院。多变量逻辑回归用于估计HF与淀粉样变性和临床结果之间的关联。
结果：在1,593,360例符合纳入标准的HF住院患者中，2,846（0.18％）患有心力衰竭，继发诊断为淀粉样变性，与8,515例没有淀粉样变性的心力衰竭住院治疗相匹配。患有淀粉样变性的HF住院治疗与肾脏疾病的患病率较高相关（56％vs.45%），恶性肿瘤(20%与4%),和更高的住院死亡率(6%vs.3％），与无淀粉样变性的HF相比。在调整后的分析中，心力衰竭伴淀粉样变性与住院死亡率的几率较高相关(比值比:1.46;95%置信区间[CI]:1.17-1.82),30天再入院(赔率比：1.17；95%CI：1.05至1.31)，和更长的平均住院时间（最小二乘平均差：1.46；95%CI：1.12至1.80）。
结论：在失代偿性HF住院患者中，淀粉样变性的存在与较高的住院患者死亡率和30日再入院风险相关.
目的：我们调查了住院心力衰竭患者中淀粉样变性的患病率和预后意义。
方法：在2010年1月1日至2015年8月31日期间，在全国再入院数据库中确定的所有主要诊断为HF的住院治疗均分为有和没有淀粉样变性的继发性诊断。然后在入院年份以3:1的方式将患有淀粉样变性的HF住院与没有淀粉样变性的HF住院进行匹配。排放季度，年龄,性别,和Charlson合并症指数。主要结果是住院死亡率和30天再入院。多变量逻辑回归用于估计HF与淀粉样变性和临床结果之间的关联。
结果：在1,593,360例符合纳入标准的HF住院患者中，2,846（0.18％）患有心力衰竭，继发诊断为淀粉样变性，与8,515例没有淀粉样变性的心力衰竭住院治疗相匹配。患有淀粉样变性的HF住院治疗与肾脏疾病的患病率较高相关（56％vs.45%），恶性肿瘤(20%与4%),和更高的住院死亡率(6%vs.3％），与无淀粉样变性的HF相比。在调整后的分析中，心力衰竭伴淀粉样变性与住院死亡率的几率较高相关(比值比:1.46;95%置信区间[CI]:1.17-1.82),30天再入院(赔率比：1.17；95%CI：1.05至1.31)，和更长的平均住院时间（最小二乘平均差：1.46；95%CI：1.12至1.80）。
结论：在失代偿性HF住院患者中，淀粉样变性的存在与较高的住院患者死亡率和30日再入院风险相关.
