在HFpEF中并发症模式和死亡率:一个追溯的纵向队列研究
Mohammed Yousufuddin1, Zeliang Ma1, Ebrahim Barkoudah2
1Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
概括
随心衰竭的伴随性疾病与保存的喷射分数 (HFpEF) 增加死亡风险,特别是在发病后的三年内. 早期检测和SGLT2i治疗可以减轻这些风险,改善HFpEF患者的治疗结果.
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:
- 伴随性疾病 (CCs) 在心力衰竭中普遍存在,并与预后不佳有关.
- 伴随性疾病持续时间对HFpEF住院后的长期死亡率的影响尚不清楚.
研究的目的:
- 研究因HFpEF住院患者入院前并发症的持续时间与长期死亡率之间的关联.
- 评估伴随性疾病持续时间如何影响不同患者亚组和治疗策略的死亡风险.
主要方法:
- 在2010年至2022年期间,对9256名因HFpEF住院的成年患者进行了回顾性分析.
- 伴随性疾病按持续时间分类 (新,早期,中期,长期). 使用考克斯回归分析死亡风险,根据GWTG得分和SGLT2i处方分层.
主要成果:
- 超过2.7年的中位数随访,64.1%的患者死亡. 大多数并发症增加了死亡风险 (HRs1.06-1.25),神经疾病,CKD,中风和贫血的风险最高.
- 死亡风险在并发症发病后3年内显著增加,然后稳定下来.
- SGLT2i治疗减少了大多数并发症的死亡风险,但对中风,CKD,慢性肺部和神经疾病的残留风险仍然存在.
结论:
- 伴随性疾病显著提高HFpEF患者的死亡风险,在前三年内观察到的最高影响.
- 伴随性疾病的预后影响在不同的GWTG得分中是一致的.
- 用SGLT2抑制剂治疗显示出减轻并发症相关死亡风险的潜力,强调需要及时干预和优化治疗.
相关概念视频
01:17Pathophysiology of Heart Failure
2.8K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
2.8K
01:27Heart Failure I: Introduction
676
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
676
01:26Heart Failure III: Clinical Manifestations
465
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
465
01:29Heart Failure II: Pathophysiology
704
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
704
01:30Heart Failure V: Medical Management
209
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
209
01:30Heart Failure IV: Classification and Diagnostic Evaluation
313
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
313