心力衰竭患者住院病死率15年趋势分析

Long-term trends of in-hospital mortality in patients with heart failure:from 1993 to 2007

目的调查15年间心力衰竭住院患者在院30 d病死率的变化趋势和住院日情况。方法选择1993年1月1日至2007年12月31日15年间的心力衰竭住院患者7319例(男4543例,女2776例),统计心力衰竭住院患者在院病死率及住院日,采用Kaplan-Meier生存曲线统计不同时段的生存时间。结果 15年间心力衰竭住院患者年龄呈增长趋势(P=0.000),平均住院日呈下降趋势(P=0.000)。在院30 d病死率从1993—1997年的7.0%,到1998—2002年的4.5%,再到2003—2007年的5.1%(P=0.002)。不同性别在不同时段的在院病死率差异无统计学意义。以心肌梗死、瓣膜性心脏病为病因的心力衰竭患者在院病死率下降极为显著(P<0.01)。Kaplan-Meier生存曲线显示,时段与病死率相关(2003—2007年比1993—1997年,HR 0.59,95%CI 0.46～0.76,P<0.001)。结论调整年龄后心力衰竭住院患者在研究时段30 d在院病死率呈显著下降趋势,平均住院日呈下降趋势,住院患者年龄呈显著增高趋势。

Objective To investigate the long-term trends of in-hospital mortality and length of stay in hospitalized patients with congestive heart failure （CHF）. Methods A retrospective study was performed in 7319 patients （4543 males,2776 females） with diagnosis of CHF hospitalized from January 1, 1993 to December 31, 2007. In-hospital mortality, length of stay and survival rate were analyzed for all patients. Results During the 15-year period, the age of the patients hospitalized for CHF was increased significantly （ P = 0. 000 ） and the length of stay was reduced significantly （ P = 0. 000 ）. In-hospital mortality was decreased from 7.0% during 1993 - 1997 to d. 5% during 1998 - 2002, and to 5. 1% during 2003 - 2007 （ P = 0. 002）. There was no significant difference in gender of the patients with CHF. In-hospital mortality of myocardial infarction and valvular heart disease associated with CHF was decreased significantly （P 〈 0. O1 ） Kaplan-Meier survival curves showed that in-hospital mortality rate was associated with the study period （2003 -2007 vs. 1993 - 1997, HR O. 59, 95% CI O. 4643.76, P 〈 0. 001 ）. Conclusions During the study period, in-hospital mortality is decreased significantly, length of stay is reduced and the age of the patients hospitalized for CHF is increased significantly.