北京地区急诊心力衰竭患者三年预后、治疗现状及预后危险因素分析

发布时间：2018-06-16 17:30

本文选题：心力衰竭 + 全因死亡　；参考：《北京协和医学院》2016年博士论文

【摘要】：研究背景：心力衰竭(简称心衰,HF)作为各种心脏病的严重和终末阶段,具有高发病率、高反复住院率及高病死率的特点,是老年慢性疾病患者死亡的重要原因。急诊科在心衰患者的诊治中具有关键作用。我国心力衰竭患者数量众多,但国内目前尚无针对急诊科内心衰人群的大型注册研究,对国内心衰患者远期预后和治疗情况的研究亦甚少。目的：观察目前我国急性心衰患者治疗的现状及远期预后情况,比较HFpEF患者与HFrEF患者终点事件发生率的差异,比较新发AHF患者与慢性HF恶化患者终点事件发生率的差异,分析β RB、ACEI/ARB和MRA的应用情况及对于终点事件发生率的影响,探讨影响北京地区心衰患者预后的危险因素。方法：对“北京地区急性心衰登记研究”中纳入的HF患者进行3年随访,收集患者3年全因死亡、心血管事件及心衰再住院事件的发生情况以及治疗情况,总结事件发生率及治疗现状,按照患者基线资料将其分为HFpEF组和HFrEF组,按照既往心衰住院史分为新发AHF组和慢性HF恶化组,进行统计分析。结果：1.研究共纳入3335例患者,人群平均年龄为67.4±15.8岁,男性占53.2%,随访至患者入选三年(第1080天)时,3年失访率15.23%。2.整体人群3年全因死亡率为47.22%,3年心血管事件发生率为61.08%,3年心衰再住院率为51.63%,其中,慢性HF患者的3年全因死亡率、心血管事件发生率及心衰再住院率高于新发AHF者(49.52%vs 44.93%,61.94%vs 60.22%,53.18%vs 50.09%,P0.05),而HFrEF患者与HFpEF患者3年全因死亡率与心血管事件发生率相似(41.98%vs 41.55%,62.50%vs 60.96%,P0.05),HFrEF患者3年心衰再住院率略高于HFpEF患者(55.44%vs 51.30%,P=0.042)。3.北京地区急性心衰患者3年随访应用神经内分泌阻滞剂——β RB、ACEI/ARB和MRA类的比例分别为50.9%,40.8%和45.9%,其中HFrEF患者应用率明显高于HFpEF患者。患者应用神经内分泌阻滞剂可以明显减低心衰患者3年随访全因死亡率、心血管事件发生率和心衰再住院率,且同时应用3种药物的患者预后较好(3年全因死亡率29.8%,3年心血管事件率61.1%,3年心衰再住院率38.3%),未应用神经内分泌阻滞剂的患者预后最差(3年全因死亡率66.9%,3年心血管事件率63.8%,3年心衰再住院率52.3%)。4.多因素回归分析提示影响3年全因死亡率的危险因素包括高龄、高NYHA分级、低BMI、低SBP和心率增加。结论：北京地区急性心衰患者远期预后较差,3年全因死亡率为47.22%,3年心血管事件发生率61.08%,3年心衰再住院率51.63%。虽然射血分数保留的心衰患者与射血分数减低的心衰患者临床特征有较大差异,但两者3年全因死亡率、心血管事件发生率类似。与初发AHF的患者相比,慢性心衰急性失代偿患者的3年预后明显较差,提示对于心衰发病早期开始强化治疗的重要性。神经内分泌阻滞药物(包括β受体阻滞剂、ACEI/ARB和MRA)的应用与3年预后的改善呈现明显的相关关系,且同时应用3类神经内分泌阻滞药物对于预后的改善作用更为明显。然而,北京地区急性心衰患者长期治疗现状并不令人满意,对于神经内分泌阻滞治疗药物的使用率仍然较低。多元回归分析显示高龄、高NYHA分级、低BMI、低SBP和高心率为3年全因死亡的危险因素,对于临床上判断高危病人有一定的指导意义。
[Abstract]:Background: heart failure (HF), as a serious and terminal stage of heart disease, has high incidence, high rate of hospitalization and high mortality. It is an important cause of death in the elderly patients with chronic diseases. The emergency department has a key role in the diagnosis and treatment of heart failure patients. There is not a large registration study on the emergency Kone heart failure population at present. The study on the long-term prognosis and treatment of patients with heart failure in China is very small. Objective: To observe the current status and long-term prognosis of patients with acute heart failure in China, compare the difference of the incidence of final events between HFpEF patients and HFrEF patients, and compare the new AHF patients. The difference in the incidence of endpoint events in patients with chronic HF deterioration, the application of beta RB, ACEI/ARB and MRA, and the impact on the incidence of endpoint events, and the risk factors affecting the prognosis of patients with heart failure in Beijing. Methods: a 3 year follow-up of the patients included in the "study on the acute heart failure in Beijing" was followed up for 3 years and 3 of the patients were collected. The occurrence and treatment of cardiovascular events and heart failure rehospitalization events were all due to death, cardiovascular events and heart failure rehospitalization, and the incidence and status of treatment were summarized. According to the baseline data, the patients were divided into group HFpEF and group HFrEF. According to the history of previous heart failure hospitalization, the new AHF group and the chronic HF deterioration group were divided into two groups, and the results were statistically analyzed. Results: 1. the study included 3335 In the patients, the average age of the population was 67.4 + 15.8 years, and the male accounted for 53.2%. When the patients were followed up to three years (1080th days), the 3 year loss rate of 15.23%.2. was 47.22%, the incidence of cardiovascular events in 3 years was 61.08%, and the recurrence rate of heart failure in 3 years was 51.63%, of which the mortality of 3 years in the chronic HF patients and the cardiovascular events were issued. The rate of birth and heart failure rehospitalization was higher than that of new AHF (49.52%vs 44.93%, 61.94%vs 60.22%, 53.18%vs 50.09%, P0.05), while the 3 year total cause mortality of HFrEF patients and HFpEF patients was similar to that of cardiovascular events (41.98%vs 41.55%, 62.50%vs 60.96%, P0.05), and HFrEF patients with 3 years of heart failure rehospitalization was slightly higher than those of HFpEF patients (51.30%,) .3. patients with acute heart failure in.3. Beijing area were followed up with neuroendocrine blockers - the proportion of beta RB, ACEI/ARB and MRA, respectively, 50.9%, 40.8% and 45.9%, respectively, of which the application rate of HFrEF patients was significantly higher than that of HFpEF patients. Patients with neuroendocrine blockers could significantly reduce the mortality and cardiovascular events in patients with heart failure for 3 years. Patients with 3 kinds of drugs had a better prognosis (3 years of total cause mortality 29.8%, 3 year cardiovascular events 61.1%, 3 years of heart failure rehospitalization rate 38.3%), and those who did not use neuroendocrine blockers were the worst (3 year total cause mortality 66.9%, 3 years cardiovascular event rate 63.8%, 3 heart failure recurrence rate 52.3%).4. Multivariate regression analysis suggested that the risk factors affecting all 3 year mortality included age, high NYHA grade, low BMI, low SBP, and heart rate increase. Conclusion: the long-term prognosis of patients with acute heart failure in Beijing area is poor, the mortality of 3 years is 47.22%, the incidence of cardiovascular events is 61.08%, and the rate of hospitalization of heart failure in 3 years is 51.63%. although the ejection fraction is retained. There are significant differences in the clinical characteristics of heart failure patients and patients with decreased ejection fraction in heart failure, but the incidence of cardiovascular events is similar in the 3 year total mortality rate. Compared with the first AHF patients, the 3 year prognosis of the patients with chronic heart failure is significantly worse, suggesting the importance of the early beginning of intensive treatment for heart failure. The application of blocking drugs (including beta blockers, ACEI/ARB and MRA) has a significant correlation with the improvement of the 3 year prognosis, and the improvement of the prognosis is more obvious with the use of 3 types of neuroendocrine blockers. However, the status of long-term treatment for acute heart failure in Beijing is not satisfactory, and the neuroendocrine obstruction is not satisfactory. The use of drugs for hysteretic therapy is still low. Multiple regression analysis shows that high age, high NYHA grade, low BMI, low SBP and high heart rate are the risk factors of all 3 years of death, which have certain guiding significance in the clinical judgment of high-risk patients.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R541.6

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