临床负担和预测非心血管疾病死亡率和发病率的预测因素在晚期心力衰竭中
Davide Stolfo1, Matteo Pagnesi2, Mauro Chiarito3
1Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
概括
患有晚期心力衰竭 (HF) 的患者面临显著的非心血管 (非CV) 风险. 目前的标准可以有效预测心血管死亡,但不能预测这些非心血管事件,因此需要新的风险预测器.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 公共卫生 公共卫生
背景情况:
- 心力衰竭 (HF) 患者的人口特征正在转变,导致对非心血管 (非CV) 事件的暴露增加.
- 晚期HF患者特别容易受到非CV死亡率和发病率的影响.
- 了解非CV事件的分布和预测因素对于全面的患者管理至关重要.
研究的目的:
- 调查晚期HF中非CV死亡率和发病率的流行率.
- 为了确定患者的特征与非CV事件的风险增加在这个人群中.
- 评估当前先进的高频标准在预测非CV结果中的有用性.
主要方法:
- 来自HELP-HF注册表的数据分析,根据高级HF的2018年HFA-ESC标准对患者进行分层.
- 使用竞争性风险分析来评估HFA-ESC标准与非CV结果 (死亡率和住院治疗) 之间的关联.
- 通过统计建模,确定非CV终点的额外预测因素.
主要成果:
- 在晚期肝炎患者中观察到非CV结局的实质性负担,非CV死亡率和住院率随着时间的推移而增加.
- 虽然HFA-ESC标准与心血管死亡风险增加有关,但与非心血管死亡率或住院治疗无关.
- 非CV死亡的关键预测因素包括年龄,慢性阻塞性肺病,痴呆症,保存的喷射分数,多次HF住院和血红蛋白水平.
结论:
- 晚期HF患者经历了非CV结局的重大负担,尽管不是主要的负担.
- 目前的HFA-ESC标准对于分层CV死亡风险是有效的,但不能充分预测非CV事件.
- 识别替代因素对于更好的风险分层和选择患者接受针对非CV风险降低的治疗至关重要.
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