972例门诊及住院心力衰竭患者临床特征、治疗现状及预后分析

Clinical characteristics,treatment status,and prognosis analysis of 972 outpatient and inpatient heart failure patients

目的了解真实世界中门诊及住院心力衰竭患者在临床特征、治疗情况及预后等方面的区别。方法采用前瞻性、多中心注册研究,连续入选2012年12月至2014年11月我国24家不同地区、不同级别医院的972例门诊或住院心力衰竭患者,收集患者的人口学和临床资料以及治疗情况,并在一年时进行随访。采用McNemar配对χ^(2)检验比较患者基线与随访一年时药物治疗情况的差异。采用Pearsonχ^(2)检验比较门诊及住院患者临床资料、治疗情况及结局的差异。结果门诊患者610例(62.8%),门诊患者年龄<65岁占比高于住院患者[44.9%(274/610)vs 35.1%(127/362),P<0.05],NYHAⅢ/Ⅳ级占比高达50.8%(310/610),92.5%(564/610)的门诊患者走坡路时呼吸困难。27.9%(170/610)的门诊患者颈静脉压>6 cmH 2O,24.3%(148/610)的门诊患者存在肺部湿罗音。门诊患者和住院患者心力衰竭主要病因方面无明显差别(P=0.063),缺血性心肌病均为主要原因。基线时门诊患者中β-受体阻滞剂的使用率大于住院患者[63.0%(384/610)vs 54.4%(197/362),P<0.05],利尿剂和醛固酮受体拮抗剂使用率低于住院患者[53.1%(324/610)vs 72.1%(261/362),49.5%(302/610)vs 61.3%(222/362),P<0.05],两组ACEI/ARB的使用率差异无统计学意义[67.4%(411/610)vs 62.4%(226/362),P>0.05]。一年随访时门诊患者ACEI/ARB使用率降低[63.5%(360/567)vs 67.4%(411/610),P<0.05],住院患者醛固酮受体拮抗剂使用率降低[50.3%(165/328)vs 61.3%(222/362),P<0.05]。两组患者一年全因死亡率接近[6.7%(41/610)vs 9.4%(34/362),P=0.124],门诊组因心力衰竭住院率低于住院患者[25.4%(155/610)vs 36.5%(132/362),P<0.05],但仍>25.0%。结论门诊心力衰竭患者症状、体征仍较明显,且预后较差。门诊心力衰竭患者的规范管理不容忽视。

ObjectivesTo understand the differences in clinical characteristics,treatment status,and prognosis between outpatient and inpatient heart failure patients in the real world.MethodsA prospective,multicenter registration study was conducted to select 972 outpatient or inpatient heart failure patients from 24 different regions and levels of hospitals in China from December 2012 to November 2014.Demographic and clinical data,as well as treatment status,were collected and followed up at 1 year.The difference in medication treatment status between baseline and 1-year follow-up was compared using McNemar pairedχ^(2) test.Pearsonχ^(2) test was used to compare the differences in clinical data,treatment status,and outcomes between outpatient and inpatient patients.ResultsThere were 610 outpatient patients(62.8%),and the proportion of outpatient patients under 65 years old was higher than that of hospitalized patients[44.9%(274/610)vs 35.1%(127/362),P<0.05].The proportion of NYHA gradeⅢ/Ⅳpatients was as high as 50.8%(310/610),and 92.5%(564/610)of outpatient patients had difficulty breathing while walking uphill.27.9%(170/610)of outpatient patients had jugular vein pressure greater than 6 cmH 2O,and 24.3%(148/610)of outpatient patients had pulmonary moist rales.There was no significant difference in the main causes of heart failure between outpatient and inpatient patients(P=0.063),with ischemic cardiomyopathy being the main cause.At baseline,the use of beta blockers in outpatient patients was higher than that in hospitalized patients[63.0%(384/610)vs 54.4%(197/362),P<0.05],while the use of diuretics and aldosterone receptor antagonists was lower than that in hospitalized patients[53.1%(324/610)vs 72.1%(261/362),49.5%(302/610)vs 61.3%(222/362),P<0.05].There was no statistically significant difference in the use of ACEI/ARB between the two groups[67.4%(411/610)vs 62.4%(226/362),P>0.05].At one-year follow-up,the use of ACEI/ARB in outpatient patients decreased[63.5%(360/567)vs 67.4%(411/610),P<0.05],the usage rate of aldosterone receptor antagonists in hospitalized patients decreased by[50.3%(165/328)vs 61.3%(222/362),P<0.05].The one-year all-cause mortality rate of the two groups of patients was close to[6.7%(41/610)vs 9.4%(34/362),P=0.124],The hospitalization rate for heart failure in the outpatient group was lower than that of hospitalized patients[25.4%(155/610)vs 36.5%(132/362),P<0.05],but still>25.0%.ConclusionsOutpatient heart failure patients still have obvious symptoms and signs,and the prognosis is poor.The standardized management of outpatient heart failure patients cannot be ignored.