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Anemia, Mortality, and Hospitalizations in Heart Failure With a Preserved Ejection Fraction (from the TOPCAT Trial).

射血分数保留的心力衰竭患者的贫血、死亡率和住院率 (来自TOPCAT试验)。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.01.046
  • 作者列表:"Gupta K","Kalra R","Rajapreyar I","Joly JM","Pate M","Cribbs MG","Ather S","Prabhu SD","Bajaj NS
  • 发表时间:2020-05-01
Abstract

:In this post-hoc analysis of the TOPCAT trial, we evaluated the prognostic role of anemia in adverse cardiovascular (CV) outcomes in heart failure with a preserved ejection fraction (HFpEF). Anemia was defined as hemoglobin of <12 g/dl in females and <13 g/dl in males. The primary outcome was a composite of CV mortality, aborted cardiac arrest (ACA), and heart failure (HF) hospitalization. Secondary outcomes were components of the primary outcome, all-cause, CV and non-CV mortality, cause-specific CV and non-CV mortality, all-cause and HF hospitalization, myocardial infarction, and stroke. Among 1,748 patients from TOPCAT-Americas, patients with anemia had a 52% higher risk of the primary outcome (hazard ratio [HR] 1.52, 95% confidence interval 1.27, 1.83, p<0.05) during a median follow up of 2.4 years. These patients were also at higher risk of all-cause and CV mortality with no difference in non-CV mortality. Among CV causes, patients with anemia had higher risk of sudden cardiac death (SCD)/ACA and presumed CV death with no difference in death due to pump failure. Among non-CV causes, patients with anemia had higher risk of death due to malignancy (HR 2.61, p<0.05). Patients with anemia had higher risk of all-cause and HF hospitalizations (HR 1.26 and 1.56, respectively, p<0.05 for both). There was no difference in the risk of myocardial infarction or stroke. In conclusion, patients with HFpEF and anemia are at higher risk of mortality and hospitalization. Anemia is a significant risk factor for SCD/ACA, death due to presumed CV causes and malignancy in HFpEF.

摘要

在TOPCAT试验的事后分析中,我们评估了贫血在射血分数保留的心力衰竭 (HFpEF) 心血管 (CV) 不良结局中的预后作用。贫血定义为女性的血红蛋白 <12g/dl,男性的血红蛋白 <13g/dl。主要结局是CV死亡率、心搏骤停 (ACA) 和心力衰竭 (HF) 住院的复合结局。次要结局是主要结局的组成部分,全因,CV和非CV死亡率,原因特异性CV和非CV死亡率,全因和HF住院,心肌梗死和卒中。在来自TOPCAT美洲的1,748例患者中,在52% 年的中位随访期间,贫血患者的主要结局风险高1.52 (风险比 [HR] 95%,1.27置信区间1.83,0.05,p <2.4)。这些患者的全因死亡率和CV死亡率也较高,而非CV死亡率无差异。在CV原因中,贫血患者心脏性猝死 (SCD)/ACA和假定的CV死亡的风险较高,而泵衰竭导致的死亡没有差异。在非CV原因中,贫血患者因恶性肿瘤死亡的风险较高 (HR 2.61,p<0.05)。贫血患者全因和心力衰竭住院的风险较高 (HR分别为1.26和1.56,p均 <0.05)。心肌梗死或中风的风险没有差异。总之,HFpEF和贫血患者的死亡率和住院风险较高。在HFpEF中,贫血是SCD/ACA、由于假定的CV原因导致的死亡和恶性肿瘤的显著危险因素。

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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"]

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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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