摘要
目的 评估75岁以上男性冠心病(CHD)合并慢性心力衰竭(CHF)患者的长期预后及影响这一特定人群预后的因素.方法 回顾性收集2010年3月至7月南部战区总医院收治的75岁及以上男性CHD患者853例,分为合并CHF组(124例)和未合并CHF组(729例),采用Cox比例风险模型分析两组患者的全因死亡和心血管疾病死亡风险,并通过SHAP特征贡献图可视化CHF患者预后因素的影响程度.结果 研究对象的中位年龄为82.00(80.00,85.00)岁.在159个月的随访中,患者1年、5年和13年因心血管事件发生的再入院率分别为22.40％、41.10％和55.50％,合并CHF组的心血管事件再入院率(79.03％)高于未合并CHF组(48.56％).合并CHF组与未合并CHF组的全因死亡率分别为91.13％和60.22％(HR=2.21,95％CI:1.68～2.91),心血管疾病死亡率分别为37.90％和10.43％(HR=2.37,95％CI:1.59～3.53).多因素Cox回归模型表明,年龄、饮酒、心肌梗死病史、总胆固醇水平和按医嘱服用他汀类药物是影响CHF患者全因死亡和心血管死亡的共同因素(P＜0.05).SHAP特征贡献图显示脑卒中(HR=1.30,95％CI:1.11～1.60,P=0.002)和心肌梗死(HR=3.50,95％CI:2.40～5.10,P＜0.001)可能分别是全因死亡和心血管疾病死亡影响效应最大的特征因子.结论 75岁以上男性CHD合并CHF患者的全因死亡和心血管疾病死亡风险以及再入院率均高于未合并CHF组,且患者预后与高龄、多病共存、用药情况以及不良生活行为等多方面因素有关.
Abstract
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.
基金项目
国家老年疾病临床医学研究中心项目(NCRCG-PLAGH-2023006)
广州市科技计划(2023A03J0170)
广州市科技计划(2024B03J1245)
广州市科技计划(202102021264)
老年长期照护教育部重点实验室开放基金(LN2DPY-2023-01)
NETL
NSTL
万方数据