老年心力衰竭住院患者非心血管共病趋势的探讨

The trend of non-cardiovascular comorbidities in elderly inpatients with heart failure

目的对心力衰竭(HF)住院患者非心血管共病患病率的时间趋势进行描述。方法研究选取中国人民解放军南部战区总医院住院的离退休老年560例患者的数据(2003—2012年),评估HF住院患者中非心血管共病(慢性阻塞性肺疾病/哮喘、贫血、糖尿病、肥胖(体质指数≥30 kg/m^2)和肾功能损害的患病率和趋势。结果 0、1、2和≥3种非心血管共病的患病率分别为20%、30%、25%和25%。从2003—2012年,0种非心血管共病患者数量下降(由20%到16%,P<0.000 1)和≥3种非心血管共病患者增加(由25%到32%,P<0.000 1)。在研究人群中,1种非心血管共病患者的30 d调整病死率风险增加(危险比=1.16;95%置信区间:1.09～1.24,P<0.000 1),2种非心血管共病(危险比=1.34;95%置信区间:1.25～1.44,P<0.000 1)和≥3种非心血管共病(危险比=1.63;95%置信区间:1.51～1.75;P<0.000 1)。住院病死率也出现了类似的趋势。结论随着时间的推移,因HF住院的患者有越来越多的非心血管共病,这与更差的预后相关。应对非心血管共病日益加重的负担的策略可能是改善预后的一个途径,应该被纳入医院提供的HF治疗中。

Objective To investigate the time trend of non-cardiovascular comorbidities in inpatients with heart failure. Methods The data of 560 retired elderly patients hospitalized in Guangzhou General Hospital of Guangzhou Military Region(2003-2012) were selected to evaluate the prevalence and trend of non-cardiovascular comorbidities(chronic obstructive pulmonary disease/asthma, anemia, diabetes, obesity and renal dysfunction) among inpatients with heart failure. Results The prevalence of 0, 1, 2 and ≥ 3 non-cardiovascular comorbidities among the patients were 20%, 30%, 25% and 25%, respectively. From 2003 to 2012, the 0 non-cardiovascular comorbid patients were significantly reduced(20% to 16%, P<0.0001), while ≥ 3 non-cardiovascular comorbid patients were significantly increased(25% to 32%, P<0.000 1). In the study population, the 30-day adjusted mortality risks of 1 non-cardiovascular comorbid patients(HR=1.16;95% CI:1.09-1.24;P<0.000 1), 2 non-cardiovascular comorbid patients(HR=1.34;95%CI:1.25-1.44;P<0.000 1) and ≥ 3 non-cardiovascular comorbid patients were all significantly increased(HR=1.63;95% CI:1.51-1.75;P<0.000 1). A similar trend has also observed in hospital mortality. Conclusions More patients hospitalized for heart failure have non-cardiovascular comorbidities are revealed, suggesting worse prognosis. Strategies to cope with the increasing burden of non-cardiovascular comorbidities may be a way to improve prognosis, and should be included in heart failure treatment.