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Ischemic heart failure as a complication of incident acute myocardial infarction: Timing and time trends: A national analysis including 78,814 Danish patients during 2000-2009.

缺血性心力衰竭作为急性心肌梗死事件的并发症: 时间和时间趋势: 一项包括 78,814-2000 年期间 2009 例丹麦患者的全国性分析。

  • 影响因子:1.61
  • DOI:10.1177/1403494819829333
  • 作者列表:"Sulo G","Sulo E","Jørgensen T","Linnenberg A","Prescott E","Tell GS","Osler M
  • 发表时间:2020-05-01
Abstract

:Aim: Heart failure is a serious complication of acute myocardial infarction leading to poor prognosis. We aimed at exploring time trends of heart failure and their impact on mortality among patients with an incident acute myocardial infarction. Methods: From the National Patient Danish Registry we collected data on all patients hospitalized with an incident of acute myocardial infarction during 2000-2009 and identified cases with in-hospital heart failure (presented on admission or developing heart failure during acute myocardial infarction hospitalization) or post-discharge heart failure (a hospitalization or outpatient visit following acute myocardial infarction discharge), and assessed in-hospital, 30-day and 1-year mortality. Results: Of the 78,814 patients included in the study, 10,248 (13.0%) developed in-hospital heart failure. The odds of in-hospital heart failure declined 0.9% per year (odds ratio=0.991, 95% confidence interval: 0.983-0.999). In-hospital heart failure was associated with 13% (odds ratio=1.13, 95% confidence interval: 1.06-1.20) and 14% (odds ratio=1.14, 95% confidence interval: 1.07-1.20) higher in-hospital and 30-day mortality, respectively. Of the 61,637 patients discharged alive without in-hospital heart failure, 5978 (9.7%) experienced post-discharge heart failure, 4116 (6.7%) were hospitalized and 1862 (3.0%) were diagnosed at outpatient clinics. The risk of heart failure requiring hospitalization declined 5.5% per year (hazard ratio=0.945, 95% confidence interval: 0.934-0.955) whereas the risk of heart failure diagnosed at outpatient clinics increased 13.4% per year (hazard ratio=1.134, 95% confidence interval: 1.115-1.153). Post-discharge heart failure was associated with 239% (hazard ratio=3.39, 95% confidence interval: 3.18-3.63) higher 1-year mortality. Conclusions: In-hospital and post-discharge heart failure requiring hospitalization decreased whereas post-discharge heart failure diagnosed at outpatient clinics increased among incident acute myocardial infarction patients during 2000-2009. The development of heart failure, especially after acute myocardial infarction discharge, indicates a poor prognosis.

摘要

目的: 心力衰竭是急性心肌梗死的严重并发症,预后不良。我们旨在探索心力衰竭的时间趋势及其对急性心肌梗死患者死亡率的影响。方法: 从丹麦国家患者登记处,我们收集了 2000-2009 年期间因急性心肌梗死住院的所有患者的数据,并确定了住院期间心力衰竭 (入院时或心脏发育中出现) 的病例。急性心肌梗死住院期间失败) 或出院后心力衰竭(急性心肌梗死出院后住院或门诊就诊),并评估住院、 30 天和 1 年死亡率。结果: 在纳入研究的 78,814 例患者中,10,248 例 (13.0%) 发生院内心力衰竭。住院心力衰竭的几率每年下降 0.9% (比值比 = 0.991,95% 置信区间: 0.983-0.999)。院内心力衰竭与 13% (比值比 = 1.13,95% 置信区间: 1.06-1.20) 和 14% (比值比 = 1.14,95% 置信区间: 1.07-1.20) 相关住院和 30 天死亡率分别较高。出院时无院内心衰的 61,637 例患者中,出院后心衰 5978 例 (9.7%),住院 4116 例 (6.7%),住院 1862 例 (3.0%) 在门诊被诊断。需要住院治疗的心力衰竭风险每年下降 5.5% (风险比 = 0.945,95% 置信区间: 0.934-0.955) 而在门诊诊断为心力衰竭的风险每年增加 13.4% (风险比 = 1.134,95% 置信区间: 1.115-1.153)。出院后心力衰竭与 239% (风险比 = 3.39,95% 置信区间: 3.18-3.63) 较高的 1 年死亡率相关。结论: 在 2000-2009 期间,急性心肌梗死事件患者中需要住院治疗的院内和出院后心力衰竭减少,而门诊诊断的出院后心力衰竭增加。心力衰竭的发展,特别是急性心肌梗死出院后,提示预后不良。

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相关文献
影响因子:1.61
发表时间:2020-05-01
DOI:10.1177/1403494819829333
作者列表:["Sulo G","Sulo E","Jørgensen T","Linnenberg A","Prescott E","Tell GS","Osler M"]

METHODS::Aim: Heart failure is a serious complication of acute myocardial infarction leading to poor prognosis. We aimed at exploring time trends of heart failure and their impact on mortality among patients with an incident acute myocardial infarction. Methods: From the National Patient Danish Registry we collected data on all patients hospitalized with an incident of acute myocardial infarction during 2000-2009 and identified cases with in-hospital heart failure (presented on admission or developing heart failure during acute myocardial infarction hospitalization) or post-discharge heart failure (a hospitalization or outpatient visit following acute myocardial infarction discharge), and assessed in-hospital, 30-day and 1-year mortality. Results: Of the 78,814 patients included in the study, 10,248 (13.0%) developed in-hospital heart failure. The odds of in-hospital heart failure declined 0.9% per year (odds ratio=0.991, 95% confidence interval: 0.983-0.999). In-hospital heart failure was associated with 13% (odds ratio=1.13, 95% confidence interval: 1.06-1.20) and 14% (odds ratio=1.14, 95% confidence interval: 1.07-1.20) higher in-hospital and 30-day mortality, respectively. Of the 61,637 patients discharged alive without in-hospital heart failure, 5978 (9.7%) experienced post-discharge heart failure, 4116 (6.7%) were hospitalized and 1862 (3.0%) were diagnosed at outpatient clinics. The risk of heart failure requiring hospitalization declined 5.5% per year (hazard ratio=0.945, 95% confidence interval: 0.934-0.955) whereas the risk of heart failure diagnosed at outpatient clinics increased 13.4% per year (hazard ratio=1.134, 95% confidence interval: 1.115-1.153). Post-discharge heart failure was associated with 239% (hazard ratio=3.39, 95% confidence interval: 3.18-3.63) higher 1-year mortality. Conclusions: In-hospital and post-discharge heart failure requiring hospitalization decreased whereas post-discharge heart failure diagnosed at outpatient clinics increased among incident acute myocardial infarction patients during 2000-2009. The development of heart failure, especially after acute myocardial infarction discharge, indicates a poor prognosis.

翻译标题与摘要 下载文献
影响因子:1.44
发表时间:2020-01-01
DOI:10.1080/10641963.2019.1590384
作者列表:["Ohishi M","Yoshida T","Nishigaki N","Oh A","Shimasaki Y"]

METHODS::The number of patients with heart failure (HF) is rapidly increasing. Although hypertension is related to onset of HF, antihypertensive treatment status for these patients has not been fully examined. We conducted a claims-based study to discern the treatment status of Japanese hypertensive patients with HF. Two Japanese databases (2008-2016) from acute care hospitals and health insurance societies were used to analyze prescription rates for antihypertensive drug class or category of diuretics in all hypertensive patients and the subset of patients with HF. Totals of hypertensive patients and those with HF in each database in 2015 were 4,191,666 and 1,404,008 patient-months, and 1,382,732 and 148,194 patient-months, respectively. In the acute care hospitals database, calcium channel blockers (CCBs) (55.0-56.5%) and angiotensin II receptor blockers (49.4-54.7%) were prescribed most. β-blockers (38.7-48.0%) and diuretics (42.3-45.6%) were prescribed more for hypertensive patients with HF than for all hypertensive patients (21.5-24.8% and 25.5-26.7%, respectively). Loop diuretics were also prescribed more often for hypertensive patients with HF (68.3-76.0% from acute care hospitals and 47.8-55.8% from health insurance societies) than for all hypertensive patients (56.7-61.7% and 16.4-18.3%). The size of medical institution had a greater effect on drug selection than patient age in both patient groups. Given recommendations in guidelines for hypertensive patients with HF, the differences in drug choice in comparison with all hypertensive patients appear reasonable. However, some deviations, such as the high rate of CCBs in frontline and preference for angiotensin II receptor blockers over angiotensin-converting enzyme inhibitors, did not appear to follow guidelines.

翻译标题与摘要 下载文献
影响因子:3.00
发表时间:2020-01-01
DOI:10.1016/j.diabres.2019.05.005
作者列表:["Scheen AJ"]

METHODS::The management of type 2 diabetes mellitus (T2DM) essentially consists in controlling hyperglycaemia, together with other vascular risk factors, in order to reduce the incidence and severity of diabetic complications. Whereas glucose control using classical glucose-lowering agents (except perhaps metformin) largely fails to reduce cardiovascular disease (CVD), two new pharmacological classes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is), have proven their ability to reduce major cardiovascular events in patients with established CVD. Furthermore, SGLT2is reduced the risk of hospitalisation for heart failure and the progression of renal disease. According to the 2018 ADA-EASD consensus report, the choice of a second agent to be added to metformin should now be driven by the presence or not of atherosclerotic CVD, heart failure or renal disease, all conditions that should promote the use of a SGLT2i or a GLP-1 RA with proven efficacy. Thus endocrinologists have to face a new paradigm in the management of T2DM, with a shift from a primary objective of glucose control without inducing hypoglycaemia and weight gain to a goal of cardiovascular and renal protection, largely independent of glucose control. Of note, however, the latter remains crucial to reduce the risk of microangiopathy.

心力衰竭方向

心力衰竭(heart failure)简称心衰,是指由于心脏的收缩功能和(或)舒张功能发生障碍,不能将静脉回心血量充分排出心脏,导致静脉系统血液淤积,动脉系统血液灌注不足,从而引起心脏循环障碍症候群。此种障碍症候群集中表现为肺淤血、腔静脉淤血。心力衰竭并不是一个独立的疾病,而是心脏疾病发展的终末阶段。其中绝大多数的心力衰竭都是以左心衰竭开始的,即首先表现为肺循环淤血。

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