G-CHF国际调查人员研究了心力衰竭病因、管理和预后的全球变化。2023年5月16日出版的《美国医学会杂志》发表了这项成果。

大多数心力衰竭（HF）的流行病学研究都是在高收入国家进行的，来自中低收入国家的可比数据有限。为了研究处于不同经济发展水平的国家组在HF病因、治疗和结果方面的差异，研究组招募了40个高收入、中上收入、中低收入和低收入国家的23341名参与者，随访时间中位数为2.0年。主要结局为HF病因、HF药物使用、住院治疗和死亡。

参与者的平均（SD）年龄为63.1岁（14.9岁），9119名（39.1%）为女性。HF最常见的病因是缺血性心脏病（38.1%），其次是高血压（20.2%）。高收入国家（51.1%）和中上收入国家（61.9%）联合使用β-阻滞剂、肾素-血管紧张素系统抑制剂和盐皮质激素受体拮抗剂治疗射血分数降低的HF患者比例最高，低收入国家（45.7%）和中低收入国家（39.5%）最低（P < .001）。

每100人-年的年龄和性别标准化死亡率在高收入国家最低（7.8），在中上收入国家为9.3，在中低收入国家为15.7，在低收入国家最高（19.1）。高收入国家（比率 = 3.8）和中等偏上收入国家（比率 = 2.4）的住院率高于死亡率，而在中低收入国家相差不大（比率 = 1.1），在低收入国家则住院率低于死亡率（比率 = 0.6）。

首次入院后30天病死率在高收入国家最低（6.7%），其次是中上收入国家（9.7%），然后是中低收入国家（21.1%），低收入国家最高（31.6%）。在对患者特征和长期HF治疗用药进行校正后，中低收入国家和低收入国家在首次入院30天内的死亡风险比高收入国家高3-5倍。

研究结果表明，这项针对来自40个不同国家、来自4个不同经济水平的HF患者的研究表明，HF的病因、管理和预后存在差异。这些数据可能有助于规划改善全球HF预防和治疗的方法。

Title: Global Variations in Heart Failure Etiology, Management, and Outcomes

Author: G-CHF Investigators, Mariela Rasmussen, Aldo Prado, Miguel A. Hominal, Cesar J. Zaidman, Guillermo Cursack, Ignacio MacKinnon, Gerardo Zapata, David G. Rojas, Ruben G. Duran, Oscar G. Vilamajo, Oscar P. Dutra, Lívia Oliveira, Ricardo Pavanello, César Minelli, Antonio Sousa, Lilia N. Maia, Mauro E. Hernandes, Múcio Oliveira, Weimar K. S. B. De Souza, Fernando Nobre, Nadine Clausell, Eduardo Abib, Silmeia Z. Bazan, Gilmar Reis, Nkoke Clovis, Cabral Tantchou, Joseph P. Abah, Charles K. Kouam, Anastase D. Tamdja, Guillaume E. Manon, Serah M. Abang, Stachys A. N. Feuzeu, Herve M. BanHaka, Chris N. Nganou-Gnindjio, Sih Colette, Albert Nyanga, Tchinda G. Fomekong, Jules Ndjebet, Florent A. D. Ngongang, Kim Anderson, Serge Lepage, Francois Tournoux, Normand Racine, Stuart Smith, Robert McKelvie, Gordon Moe, Shelley Zieroth, Mustafa Toma, Ying T. Sia, George Heckman, Heather Ross, Justin Ezekowitz, Mario Senechal, Elizabeth Swiggum, Mario Vega, Gabriel Jano, Braulio Bobadilla, Huiqiong Tan, Jian W. Gou, Wei Jin, Heng Jiang, Fen Ai, Wenxiu Zhou, Hai Y. Luo, Fang Wei, Zhisheng Jia, Jie Peng, Xiuhong Wang, Xioajuan Bai, Jing Xu, Xue W. Liang, XiaoPing Chen, Tianxun Wang, Tinlin Zheng, Shaoming Qin

Issue&Volume: 2023/05/16

Abstract:

Importance  Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries.

Objective  To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development.

Design, Setting, and Participants  Multinational HF registry of 23341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years.

Main Outcomes and Measures  HF cause, HF medication use, hospitalization, and death.

Results  Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P<.001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio=3.8) and in upper–middle-income countries (ratio=2.4), similar in lower–middle-income countries (ratio=1.1), and less frequent in low-income countries (ratio=0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies.

Conclusions and Relevance  This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.

DOI: 10.1001/jama.2023.5942

Source: https://jamanetwork.com/journals/jama/article-abstract/2804824