Study On The Long-term Survival Status, Independent Risk Factors And Prediction Models Of Patients With Acute Heart Failure In Beijing Area

Background:Acute heart failure(AHF)is a life-threatening disease.The majority of AHF patients are first diagnosed and treated in the emergency departments.However,clinical data exploring the outcomes of patients presenting AHF in emergency departments are limited,especially the long-term outcomes.Methods:The Beijing Acute Heart Failure Registry(Beijing AHF Registry)was a prospective,multicenter,observational study involving 3335 consecutive patients with AHF presenting to the emergency departments of 14 hospitals in Beijing from January 1,2011,to September 23,2012.The 5-year survival and treatment information of 3335 patients were followed-up.Kaplan-Meier curve and Cox proportional hazards regression model were adopted to evaluate the 5-year outcomes and associated independent risk factors.Results:11.8%patients were lost to follow-up in the fifth year.The 5-year all-cause mortality and cardiovascular death rates were 55.4%and 49.6%,respectively.The median overall survival was 34 months.The proportion of patients who were insisted on guideline recommended drug therapies including ?-blockers,angiotensin-converting enzyme inhibitors(ACEIs),angiotensin-II receptor blockers(ARBs),and spironolactone during follow-up were 30.3%,15.1%,8.0%,and 12.4%respectively.Independent risk factors of 5-year all-cause mortality were patient age(hazard ratio[HR]:1.027,95%confidence interval[CI]:1.023-1.030),fatigue(HR:1.127,95%CI:1.009-1.258),ascites(HR:1.190,95%CI:1.057-1.340),hepatic jugular reflux(HR:1.339,95%CI:1.140-1.572),NYHA class ?-?(HR:1.511,95%CI:1.291-1.769),heart rate(HR:1.003,95%CI:1.001-1.005),blood urea nitrogen(HR:1.014,95%CI:1.008-1.020),B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide level in the third(HR:1.426,95%CI:1.220-1.668)or fourth quartile(HR:1.437,95%CI:1.223-1.690),serum albumin(HR:0.981,95%CI:0.971-0.992)on emergency departments admission,AHF caused by ischemic heart diseases(HR:1.195,95%CI:1.073-1.331),or primary cardiomyopathy(HR:1.382,95%CI:1.183-1.614),comorbid with diabetes(HR:1.118,95%CI:1.010-1.237),or stroke(HR:1.252,95%CI:1.121-1.397).Body mass index(HR:0.971,95%CI:0.958-0.983),diastolic blood pressure(HR:0.996,95%CI:0.993-0.999),serum sodium(HR:0.980,95%CI:0.972-0.988),insisted on diuretics(HR:0.714,95%CI:0.626-0.814),p-blockers(HR:0.673,95%CI:0.588-0.769),ACEIs(HR:0.714,95%CI:0.604-0.845),ARBs(HR:0.790,95%CI:0.646-0.965),spironolactone(HR:0.814,95%CI:0.663-0.999),calcium antagonists(HR:0.624,95%CI:0.531-0.733),nitrates(HR:0.715,95%CI:0.631-0.811),and digoxin(HR:0.579,95%CI:0.465-0.721)during follow-up were the independent protective factors.Conclusion:The 5-year all-cause mortality of the patients in Beijing AHF Registry was 55.4%with a median survival of 34 months.The proportion of patients insisted on guideline recommended drug therapies was relatively low.Backgrounds:Acute heart failure(AHF)is a common complication of acute myocardial infarction(AMI).AHF is also a powerful predictor of poor prognosis in patients with AMI,which has important implications for treatment.The purpose of this study was to investigate the 5-year survival and prognostic factors of patients with AMI complicated with AHF who were first diagnosed and managed in emergency departments in Beijing.Methods:Patients diagnosed with AHF after AMI in the Beijing Acute Heart Failure Registry(Beijing AHF Registry)were included in this study.The outcomes of interest were 5-year all-cause mortality.Cox.regression models were adopted to examine 5-year outcomes and associated predictors.Results:A total of 395 patients were included in the study,245(62%)died during the 5-year follow-up.The proportion of patients receiving reperfusion therapy during hospitalization was 38.2%.Heart rate(HR:1.006,95%CI:1.001-1.011,P=0.022),left ventricular anterior wall myocardial infarction(HR:1.383,95%CI:1.058-1.806,P=0.0177),Killip class ?(HR:1.836,95%CI:1.246-2.704,P=0.002),atrial fibrillation(HR:1.402,95%CI:1.010-1.945,P=0.043),previous chronic kidney disease(HR:1.753,95%CI:1.246-2-2.704,P=0.002),previous stroke/transient ischemic attack(HR:1.272,95%CI:0.865-1.277,P=0.088),B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide level in the third quartile(Q3,HR:1.597,95%CI:1.026-2.486,P=0.038)were the independent risk factors.Serum sodium(HR:0.978,95%CI:0.956-1.001,P=0.064),receiving reperfusion therapy(HR:0.558,95%CI:0.412-0.755,P<0.001),adherence to diuretics(HR:0.626,95%CI:0.433-0.905,P=0.013),beta blockers(HR:0.455,95%CI:0.329-0.628,P<0.001),antiplatelet drugs(HR:0.521,95%CI:0.0.95%CI:0.433-0.905,P=0.013),and statins(HR:0.650,95%CI:0.477-0.886,P=0.006)were independent protective factors.Conclusion:The proportion of patients with AHF after AMI receiving reperfusion therapy and guideline recommended drug therapies is low,and the long-term prognosis of these patients was poor.Thus,there is still room to improve the prognosis of patients by optimizing the treatment strategy.Backgrounds:Aging and heart failure(HF)are two major public health problems in the world.The prevalence and mortality of HF are strongly associated with age.And HF is the most common cause of hospitalization and death in elderly patients.However,studies regarding HF in elderly patients were rare.This study aimed to explore the clinical characteristics,long-term prognosis,and prognostic factors of elderly patients with acute heart failure(AHF)in Beijing.Methods:Patients?70 years of age in the Beijing Acute Heart Failure Registry(Beijing AHF Registry)were included in this study.Clinical characteristics of these patients were described.The outcomes of interest were 5-year all-cause mortality.Cox regression models were adopted to examine 5-year outcomes and associated predictors in elderly patients with AHF.Results:A total of 1774 patients were included in the study.The majority of elderly patients with AHF were women(54.7%)and with preserved ejection fraction(52.3%).Ischemic cardiomyopathy(54.4%)was the most common etiology.And most patients had several co-existing diseases.The proportion of elderly AHF patients receiving guideline recommended drug therapies were low(7.3-23.8%).1209 patients(68.2%)died during 5-year follow-up with a median survival of 18 months.Independent risk factors of 5-year all-cause mortality were patient age(hazard ratio[HR]:1.031,95%confidence interval[CI]:1.021-1.041,P<0.001),heart rate(HR:1.003,95%CI:1.001-1.005,P=0.008),NYHA class ?-?(HR:1.363,95%CI:1.132-1.640,P<0.001),ascites(HR:1.322,95%Cl:1.127-1.552,P=0.001),hepatic jugular reflux(HR:1.264,95%CI:1.019-1.569,P=0.033),white blood cells(HR:1.021,95%CI:1.011-1.033,P<0.001),blood urea nitrogen(HR:1.016,95%CI:1.009-1.024,P<0.001),B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide level in the third(HR:1.567,95%CI:1.297-1.892,P<0.001)or fourth quartile(HR:1.641,95%CI:1.362-1.977,P<0.001)at admission,comorbid with chronic obstructive pulmonary disease or asthma(HR:1.156,95%CI:1.008-1.325,P=0.039),and stroke or transient ischemic attack(HR:1.246,95%CI:1.097-1.415,P=0.001).Female sex(HR:0.879,95%CI:0.783-0.986,P=0.028),body mass index(HR:0.970,95%CI:0.954-0.986,P<0.001),diastolic blood pressure(HR:0.996,95%CI:0.992-0.999,P=0.022),serum sodium(HR:0.987,95%CI:0.977-0.996,P=0.006),serum albumin(HR:0.980,95%CI:0.968-0.993,P=0.002)and insisted on diuretics(HR:0.721,95%CI:0.610-0.851,P=0.001),?-blockers(HR:0.721,95%CI:0.610-0.852,P<0.001),calcium antagonist(HR:0.693,95%CI:0'.578-0.831,P<0.001),spironolactone(HR:0.730,95%CI:0.543-0.981,P=0.037),nitrates(HR:0.649,95%CI:0.557-0.757,P<0.001)and digoxin(HR:0.629,95%CI:0.469-0.860,P=0.004)during follow-up were the independent protective factors.Conclusion:The majority of elderly patients with AHF were women and with preserved ejection fraction,and often comorbid with several co-existing diseases.The proportion of elderly AHF patients insisted on guideline recommended drug therapies was low,and their long-term prognosis were poor.Individualized management based on multidisciplinary comprehensive evaluation may help to improve the prognosis of elderly patients with AHF.Backgrounds:Acute heart failure(AHF)is a life-threatening disease.Patients with AHF usually onset acutely and most of them are first diagnosed and managed in the emergency departments.Underestimation of the risk of AHF patients may lead to the delay of treatment and increase the risk of death.Prediction models can help clinicians to identify patients with high risk in time,simplify the process and improve efficiency.In this study,we used the Beijing Acute Heart Failure Registry as model derived cohort to establish a survival prediction model for Chinese patients with AHF.Methods:Patients in the Beijing Acute Heart Failure Registry were analyzed in this study.10-fold nested-cross-validation(10-nCV),Cox regression and elastic-net methods were used to screen the baseline and therapeutic characteristics of patients.Multivariate regression and nomogram were used to establish the prediction models of 1-,3-,and 5-year survival based on the baseline characteristics and baseline+therapeutic characteristics.Concordance index(C-index)and calibration plot were adopted to validate the discrimination and calibration ability of models.Results:After screening,18 variables highly related to 5-year survival were included in the prediction model.Including 11 baseline characteristics(age,body mass index,history of stroke,hepatic jugular reflux,NYHA class ?-?,diastolic blood pressure,serum sodium,urea nitrogen,albumin,B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide level)and 7 therapeutic characteristics(long-term use of diuretics,?-blockers,angiotensin-converting enzyme inhibitors,calcium antagonists,spironolactone,nitrates and digoxin).The nomograms and individualized clinical prediction models based on baseline characteristics and baseline+therapeutic characteristics were constructed to evaluate the 1-,3-,and 5-year survival.The C-index of the baseline characteristics model and the baseline+therapeutic characteristics model were 0.690(0.677-0.703)and 0.752(0.740-0.763),respectively.The calibration curve indicated that the 1-,3-,and 5-year survival rates predicted by the model were well calibrated.Conclusion:In this study,we established individual prediction models based on Chinese patients with AHF,and drew nomograms that can be applied to clinical practice and predict the 1-,3-,and 5-year survival rates of patients.The results of internal validation showed that the models had good discrimination and calibration,which could provide information for the prognosis evaluation of patients with AHF.