老年心力衰竭患者出院后2年预后及影响因素

Prognosis status and its influencing factors in elderly patients with heart failure during two year-period after discharge

目的:分析老年心力衰竭患者出院后2年内的预后状况并探索影响其生存的因素。方法:随访观察146例老年心力衰竭患者出院后2年内再住院或死亡等临床资料,平均随访约15个月。分析患者预后状况,采用多因素Cox回归模型分析影响预后的因素。结果:146例患者出院后3、6、9、12、15、18、21、24个月的因心力衰竭再住院率分别为3.4%、10.9%、17.1%、19.2%、22.6%、26.0%、30.1%、35.6%;病死率分别为1.4%、2.7%、3.4%、6.8%、9.6%、12.3%、15.8%、20.5%;Cox回归分析显示,年龄>75岁的患者发生再住院或死亡的危险性是≤75岁的2.353倍;氨基末端B型脑钠肽前体(NT-proBNP)>1 000ng/L的患者发生危险性是NT-proBNP≤1 000ng/L的2.347倍;左室射血分数(LVEF)≤0.5%的患者发生危险性是LVEF>0.5%的2.105倍;血红蛋白浓度≤130g/L的患者发生危险性是血红蛋白浓度>130g/L的1.853倍;不规律服用β-受体阻滞剂的患者发生危险性是规律服用β-受体阻滞剂的1.961倍;不规律服用利尿剂的患者发生危险性是规律服用利尿剂的1.49倍。结论:老年心力衰竭患者2年内的累积再住院及病死率分别为35.6%、20.5%。年龄、NT-proBNP、LVEF、血红蛋白浓度、β-受体阻滞剂、利尿剂是影响老年心力衰竭患者2年内生存的主要因素。

Objective：To analyze prognosis status and its influencing factors in heart failure（HF）patients during two year-period after discharge.Method：There were 146 patients with the mean followed-up time of 15 months.The questionnaire survey and telephone visit were performed to collect their clinical data,and Cox regression analysis was applied to analyze influencing factors for their re-hospitalization or mortality during that period of time.Result：The re-hospitalization rate in 146 patients caused by HF at 3,6,9,12,15,18,21 and 24 months after discharge were 3.4%,10.9%,17.1%,19.2%,22.6%,26.0%,30.1% and 35.6%,respectively;the mortality were 1.4%,2.7%,3.4%,6.8%,9.6%,12.3%,15.8% and 20.5%,respectively.Cox regression study showed that over 75 years old patients with risk of readmission or death was 2.353 times than patients of less or equal to 75 years old.The risk of the patients with NT-proBNP 〉1 000 ng/L was 2.347 times more than those with NT-proBNP ≤1 000 ng/L.The risk of the patients with ejection fraction ≤0.5% was 2.105 times more than those with ejection fraction〉0.5%.The risk of the patients with hemoglobin concentration≤130 g/L was 2.105 times more than those with hemoglobin concentration 〉130 g/L.Patients who don＇t not take beta blockers were 1.961 times more than those who take them.Patients who don＇t take diuretics are 1.49 times more dangerous than those who take diuretics.Conclusion：The 2 year accumulative re-hospitalization and mortality in HF patients were 35.6% and 20.5%.Age,gender,the levels of hemoglobin,NT-proBNP and diuretics were the main influencing factors for HF patient＇s survival within 2-year.