Long-term prognostic study in elderly male patients with coronary artery disease in combination with chronic heart failure
Objective To assess the long-term prognosis of male coronary artery heart disease(CHD)combined with chronic heart failure(CHF)in over 75 years of age and the influencing factors which affect the prognosis of this specific population.Methods A total of 853 elderly male CHD patients aged 75 years and above admitted to the Southern Theatre General Hospital from March to July 2010 were retrospectively collected,divided into the combined CHF group(124 patients)and the uncomplicated CHF group(729 patients),and Cox proportional risk model was used to analyze the risk of all-cause mortality and cardiovascular disease mortality in the two groups,and the SHAP feature contribution graph was used to visualize the prognosis of patients with CHF the degree of influence of the factors.Results The median age of the patients was 82.00(80.00,85.00)years.At 159 months of follow-up,the readmission rates of patients for cardiovascular events at 1,5 and 13 years were 22.40％,41.10％and 55.50％,respectively,and the rate of readmission for cardiovascular events was higher in the combined CHF group(79.03％)than in the not combined CHF group(48.56％).The all-cause mortality rate was 91.13％and 60.22％(HR=2.21,95％CI:1.68-2.91),and the cardiovascular disease mortality rate was 37.90％and 10.43％(HR=2.37,95％CI:1.59-3.53)in the combined CHF group and the uncomplicated CHF group,respectively.Multifactorial Cox regression modelling showed that age,alcohol consumption,history of myocardial infarction,total cholesterol level and statins as prescribed were common factors influencing all-cause and cardiovascular deaths in patients with CHF(P＜0.05).The SHAP characteristic contribution plots showed that stroke(HR=1.30,95％CI:1.11-1.60,P=0.002)and myocardial infarction(HR=3.50,95％CI:2.40-5.10,P＜0.001)might be the factors with the largest impact effect on all-cause mortality and cardiovascular disease mortality,respectively.Conclusions The risk of both all-cause and cardiovascular death and the readmission rate were higher in men over 75 years of age with CHD combined with CHF than in the group without CHF,and the prognosis of the patients was related to a number of factors,including advanced age,multimorbidity,use of medication,and poor lifestyle behaviors.
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