射血分数改善/恢复的心力衰竭患者全因死亡率、再住院率及复合终点发生率的Meta分析

All-cause Mortality,Rehospitalization Rate and Composite Endpoint Incidence Rate in Patients with Heart Failure with Improved Ejection Fraction or Heart Failure with Recovered Ejection Fraction:a Meta-analysis

目的 系统评价射血分数改善的心力衰竭(HFimpEF)/射血分数恢复的心力衰竭(HFrecEF)患者全因死亡率、再住院率及复合终点发生率。方法 计算机检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网等数据库中HFimpEF/HFrecEF患者预后相关文献,检索时限为建库至2023年1月。主要结局指标包括全因死亡率,次要结局指标包括再住院率及复合终点发生率。提取纳入文献的资料,采用纽卡斯尔-渥太华量表(NOS)评价文献质量,采用Stata 14.0与RevMan 5.4软件进行Meta分析。结果 本研究纳入11篇文献,共包含射血分数降低的心力衰竭(HFrEF)患者5 873例,射血分数保留的心力衰竭(HFpEF)患者1 819例,HFimpEF患者465例,HFrecEF患者1 583例。Meta分析结果显示,HFimpEF/HFrecEF患者全因死亡率低于HFrEF患者[风险比(HR)=2.35,95%CI(1.85,2.99),P<0.000 01]和HFpEF患者[HR=1.99,95%CI(1.56,2.54),P<0.000 01]。HFimpEF/HFrecEF患者再住院率低于HFrEF患者[HR=1.61,95%CI(1.41,1.85),P<0.000 01]和HFpEF患者[HR=1.47,95%CI(1.23,1.76),P<0.000 1]。HFimpEF/HFrecEF患者复合终点发生率低于HFrEF患者[HR=1.75,95%CI(1.28,2.40),P=0.000 5]和HFpEF患者[HR=1.63,95%CI(1.24,2.16),P=0.000 5]。根据发表年份、国家、研究类型、随访时间、校正因素数量进行亚组分析,结果显示,在不同亚组中HFimpEF/HFrecEF患者全因死亡率均低于HFrEF患者(P<0.05)。结论 现有证据显示,HFimpEF/HFrecEF患者全因死亡率、再住院率、复合终点发生率低于HFrEF、HFpEF患者。

Objective To systematically evaluate the all-cause mortality,rehospitalization rate and composite endpoint incidence rate in patients with heart failure with improved ejection fraction(HFimpEF)or heart failure with recovered ejection fraction(HFrecEF).Methods Databases including Cochrane Library,PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Data and VIP were retrieved to search for studies on the prognosis of HFimpEF/HFrecEF patients from database establishment to January 2023.The primary outcome indicator was all-cause mortality,the secondary outcome indicators were readmission rate and composite endpoint incidence rate.The data of the included literature were extracted,the Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the studies.Stata 14.0 and RevMan 5.4 were used for meta-analysis.Results A total of 11 articles were included,and involving 5873 heart failure with reduced ejection fraction(HFrEF)patients,1819 heart failure with preserved ejection fraction(HFpEF)patients,465 HFimpEF patients,1583 HFrecEF patients.Meta-analysis results showed that the all-cause mortality of HFimpEF/HFrecEF patients was lower than that of HFrEF patients[hazard ratio(HR)=2.35,95%CI(1.85,2.99),P<0.00001]and HFpEF patients[HR=1.99,95%CI(1.56,2.54),P<0.00001].The rehospitalization rate of HFimpEF/HFrecEF patients was lower than that of HFrEF patients[HR=1.61,95%CI(1.41,1.85),P<0.00001]and HFpEF patients[HR=1.47,95%CI(1.23,1.76),P<0.0001].The composite endpoint incidence rate of HFimpEF/HFrecEF patients was lower than that of HFrEF patients[HR=1.75,95%CI(1.28,2.40),P=0.0005]and HFpEF patients[HR=1.63,95%CI(1.24,2.16),P=0.0005].Subgroup analysis was conducted according to the publication year,country,study type,follow-up time,and number of correction factors,and the results showed that the all-cause mortality of HFimpEF/HFrecEF patients in different subgroups was lower than that of HFrEF patients(P<0.05).Conclusion The available evidence shows that the all-cause mortality,rehospitalization rate and composite endpoint incidence rate of HFimpEF/HFrecEF patients are lower than those of HFrEF and HFpEF patients.