年龄对心力衰竭患者临床特征及预后的影响

目的观察年龄增长对心力衰竭（心衰）患者的临床特征及2年预后的影响。 方法回顾性分析天津医科大学总医院和天津胸科医院两所医院2014年3月至2016年2月以心衰为主要病因、纽约心脏病学会（NYHA）心功能分级Ⅱ~Ⅳ、完成2年终点事件随访且资料完整的患者1747例，按照年龄分为非老年组（<65岁）650例，普通老年组（65~79岁）718例和高龄老年组（≥80岁）379例。分析年龄增长对心衰患者临床特征和2年预后的影响。 结果非老年组、普通老年组和高龄老年组男性患者比例逐渐下降（分别为74.9%、59.2%、55.1%，χ²=53.85，P<0.001），射血分数降低心衰（HFrEF）患者比例逐渐减少（分别为49.2%、39.8%、34.6%，χ²=23.88，P<0.001），射血分数保留心衰（HFpEF）患者比例逐渐增加（分别为23.2%、32.3%、37.7%，χ²=26.73，P<0.001）；而射血分数中间值心衰（HFmrEF）患者比例差异无统计学意义（分别为27.5%、27.9%、27.7%，P>0.05）。非老年组、普通老年组和高龄老年组患者NYHA心功能Ⅳ患者比例逐渐增加（分别为19.5%、27.7%和53.3%，χ²=133.02，P<0.001）、病种数逐渐增加（P<0.001）、平均住院天数明显延长（P<0.05）。经2年随访，非老年组、普通老年组和高龄老年组患者全因死亡率、心衰再入院率及复合终点事件发生率逐渐升高（全因死亡率分别为19.1%、32.6%、44.1%，P<0.001；心衰再入院率分别为20.5%、27.7%、33.5%，P<0.001；复合终点事件发生率分别为32.8%、47.1%、63.1%，P<0.001）。与非老年组相比较，普通老年组、高龄老年组的全因死亡风险比（HR）分别为1.81［95%可信区间（1.45~2.25）］和1.67［95%可信区间（1.49~1.88）］，心衰再入院HR分别为1.41［95%可信区间（1.13~1.75）］和1.34［95%可信区间（1.18~1.51）］，复合终点事件HR分别为1.54［95%可信区间（1.30~1.83）］和1.53［95%可信区间（1.39~1.68）］。 结论随年龄增长心衰患者出现明显的性别差异，且HFrEF比例逐渐减少，HFpEF比例逐渐增加，病种数更多，心功能更差，心衰更严重，住院时间更长，2年全因死亡率、心衰再入院率及复合终点事件发生率及风险更高。

Effect of aging on clinical features and prognosis of patients with heart failure

ObjectiveTo investigate the effect of aging on clinical features and prognosis of patients with heart failure (HF). MethodsA retrospective cohort study was performed to collect data at Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016. A total of 1747 patients with complete data were followed for 2-year outcome events. These patients mainly had HF and New York Heart Association (NYHA) cardiac function classificationⅡ-Ⅳ. They were categorized into three groups based on age: 650 cases in a non-elderly group (age<65 years), 718 cases in a young elderly group (aged 65-79 years), and 379 cases in an old elderly group (age≥80 years). The effects of aging on clinical features and prognosis of HF patients were analyzed. ResultsIn the non-elderly, young elderly, and old elderly groups, the percentages of male patients decreased gradually (74.9%, 59.2%, and 55.1%, respectively, χ²=53.85, P<0.001), the percentage of patients with heart failure with reduced ejection fraction (HFrEF) also declined gradually (49.2%, 39.8%, and 34.6%, respectively, χ²=23.88, P<0.001), the percentage of patients with heart failure with preserved ejection fraction (HFpEF) increased gradually (23.2%, 32.3%, and 37.7%, respectively, χ²=26.73, P<0.001), the percentage of patients with heart failure with mid-range ejection fraction (HFmrEF) was comparable (27.5%, 27.9%, and 27.7%, P>0.05), the percentage of NYHAⅣ HF patients increased gradually (19.5%, 27.7%, and 53.3%, χ²=133.02, P<0.001), the number of comorbidities in HF patients significantly increased (3.1, 3.6, and 4.0, P<0.001), and the average length of hospitalization days significantly became longer (P<0.05). The HF patients were followed for 2-year outcome events. All-cause mortality rate (19.1%, 32.6%, and 44.1%, P<0.001), recurrent HF hospitalization (20.5%, 27.7%, and 33.5%, P<0.001), and the occurrence rate of composite endpoint increased gradually (32.8%, 47.1%, and 63.1%, P<0.001) in the non-elderly, young elderly, and old elderly groups. In contrast with the non-elderly group, the hazard ratios (HRs) of all-cause mortality in the young elderly and old elderly groups were 1.81 (95%CI: 1.45-2.25) and 1.67 (95%CI: 1.49-1.88); the HRs of HF hospitalization were 1.41 (95%CI: 1.13-1.75) and 1.34 (95%CI: 1.18-1.51); and the HRs of occurrence of composite endpoint were 1.54 (95%CI: 1.30-1.83) and 1.53 (95%CI: 1.39-1.68), respectively. ConclusionThe proportions of male patients with HF and HFrEF patients gradually decrease and the percentage of HFpEF patients gradually increases with aging. With aging, HF patients have more comorbidities, worse cardiac function, and longer hospital stay, and the risk of all-cause mortality, HF readmission, and composite endpoint events in 2 years is higher.