Abstract
Background There is no significant difference in short - term prognosis between acute heart failure (AHF)patients with reduced ejection fraction(AHFrEF)and AHF patients with preserved ejection fraction(AHFpEF),but there have been few long - term follow - up data. Objective To compare the three - year re - hospitalization rate and mortality after discharge between AHFrEF and AHFpEF,and to explore the influencing factors for re - hospitalization. Methods A total of 296 patients who were first diagnosed with AHF in Department of Emergency of the Affiliated Hospital of Inner Mongolia Medical University and Inner Mongolia People's Hospital during 2011 to 2012,were selected as study subjects. Subjects were divided into two groups according to the left ventricular ejection fraction(LVEF),AHFrEF group(LVEF < 50% ,n = 171) and AHFpEF group( LVEF ≥ 50% ,n = 125 ). The patients' gender,age,smoking history,combined disease,acute coronary syndrome( ACS),congestive heart failure( CHF),imaging examination,BNP level,and medication status after discharge were recorded. After discharge,patients were followed up for 3 years through telephone or clinic,the end point was re - hospitalization due to cardiocerebral vascular factors or death. Results There were significant difference in detection rate of hypertension,COPD,ACS,CHF,left ventricular hypertrophy,and ratio of BNP≥220 ng/ L,taking oral β receptor blockers (β-RB)between two groups(P < 0. 05). There were no significant difference in rate of re - hospitalization due to ACS,stroke and malignant arrhythmia between two groups(P > 0. 05). The rate of re - hospitalization due to heart failure and total re -hospitalization rate among AHFrEF group were significant higher than those among AHFpEF group( P < 0. 05). According to multiariable Cox proportional hazards regression model,hypertension〔HR = 1. 450,95% CI(1. 036,2. 030)〕and BNP≥220 ng/ L〔HR = 1. 894,95% CI(1. 327,2. 702)〕were independent risk factors for re - hospitalization of AHF patients( P <0. 05). One - year, two - year, and three - year survival rates among AHFrEF group were 98% ,95% and 85% , respectively. One - year,two - year,and three - year survival rates among AHFpEF group were 98% ,94% and 86% , respectively. There was significant difference in survival curve between two groups(χ2 = 6. 656,P = 0. 010). Conclusion The rate of re - hospitalization due to heart failure in three years among AHFrEF patients is higher than that among AHFpEF patients,and survival rate in three years among AHFrEF patients is lower than that among AHFpEF patients. Hypertension and high level of BNP were independent risk factors for re - hospitalization of AHF patients. The follow - up of AHFrEF patients should be strengthened,and blood pressure in patients with hypertension should be controlled well.关键词
心力衰竭/每搏输出量/住院/预后/高血压/利钠肽,脑Key words
Heart failure/Stroke volume/Hospitalization/Prognosis/Hypertension/Natriuretic peptide,brain分类
医药卫生
