背景:关于急性心力衰竭(AHF)患者的非心血管(CV)死亡的信息很少。本研究确定了发病率,时间进程,在现实世界中,与AHF患者长期非CV死亡相关的因素。
方法:ATTEND注册表,一个全国性的,前瞻性观察多中心队列研究,纳入4842例因AHF住院的连续患者。本研究的主要终点是非CV死亡。
结果:从入院开始的中位随访时间为513(范围,385-778)天。在学习期间,1183例患者死亡;356例死亡(30.1%)与CV无关。非CV死亡的比例在后期随访阶段增加(0-180天,26.7%;181-360天,38.4%;>360天,36.6%,p<0.001)。在基线调整所有变量后,年龄(危险比[HR]每十年1.6,p<0.001)和非心脏合并症,包括慢性阻塞性肺疾病(HR1.58,p=0.003),卒中病史(HR1.44,p=0.011),肾功能不全(HR1.07,估计肾小球滤过率每下降10ml/min/1.73m2,p=0.015),和血红蛋白(HR1.15每1.0g/dl下降,p<0.001)与非CV死亡密切相关。其他预测因素包括缺血性病因(HR1.33,p=0.023),先前因心力衰竭住院(HR1.34,p=0.017),C反应蛋白(HR1.04,p<0.001),和他汀类药物的使用(HR0.70,p=0.016)。
结论:AHF患者的非CV死亡发生率较高,占长期死亡率的30%。此外,非CV死亡的比例在随访后期增加.更好地理解非CV死亡和更全面地治疗非CV合并症对于进一步改善AHF患者的预后至关重要。
BACKGROUND: Little information is available on non-cardiovascular (CV) death in acute heart failure (AHF) patients. The present study determined the incidence, time course, and factors associated with long-term non-CV death in AHF patients in a real-world setting.
METHODS: The ATTEND registry, a nationwide, prospective observational multicenter cohort study, included 4842 consecutive patients hospitalized for AHF. The primary endpoint of the present study was non-CV death.
RESULTS: Median follow-up duration from admission was 513 (range, 385-778) days. Over the study period, 1183 patients died; 356 deaths (30.1%) were non-CV related. The proportion of non-CV deaths increased in the later follow-up phase (0-180days, 26.7%; 181-360days, 38.4%; >360days, 36.6%, p<0.001). After adjustment for all variables at baseline, age (hazard ratio [HR] 1.6 per decade, p<0.001) and non-cardiac comorbidities including chronic obstructive pulmonary disease (HR 1.58, p=0.003), history of stroke (HR 1.44, p=0.011), renal insufficiency (HR 1.07, per 10ml/min/1.73m2 decrease in estimated glomerular filtration, p=0.015), and hemoglobin (HR 1.15 per 1.0g/dl decrease, p<0.001) were strongly associated with non-CV death. Other predictors included ischemic etiology (HR 1.33, p=0.023), prior hospitalization for heart failure (HR 1.34, p=0.017), C-reactive protein (HR 1.04, p<0.001), and statin use (HR 0.70, p=0.016).
CONCLUSIONS: The incidence of non-CV death was high in patients with AHF, accounting for 30% of long-term mortality. Furthermore, the proportion of non-CV death increased in the later follow-up phase. Better understanding of non-CV death and more comprehensive treatment of non-CV comorbidities are vital to further improving prognosis in AHF patients.