2013年美国心力衰竭管理指南(心衰指南)-英文(16)

2013年美国心力衰竭管理指南(心衰指南)-英文

blacks having a greater 5-year mortality rate than whites (58). HF in non-Hispanic black males and females has a prevalence of 4.5% and 3.8%, respectively, versus 2.7% and 1.8% in non-Hispanic white males and females, respectively (51).

4.1. Mortality

Although survival has improved, the absolute mortality rates for HF remain approximately 50% within 5 years of diagnosis (53, 59). In the ARIC study, the 30-day, 1-year, and 5-year case fatality rates after hospitalization for HF were 10.4%, 22%, and 42.3%, respectively (58). In another population cohort study with 5-year mortality data, survival for stage A, B, C, and D HF was 97%, 96%, 75%, and 20%, respectively (47). Thirty-day postadmission mortality rates decreased from 12.6% to 10.8% from 1993 to 2005; however, this was due to lower in-hospital death rates. Postdischarge mortality actually increased from 4.3% to 6.4% during the same time frame (60). These observed temporal trends in HF survival are primarily restricted to patients with reduced EF and are not seen in those with preserved EF (40).

See Online Data Supplement 3 for additional data on mortality.

4.2. Hospitalizations

HF is the primary diagnosis in >1 million hospitalizations annually (51). Patients hospitalized for HF are at high risk for all-cause rehospitalization, with a 1-month readmission rate of 25% (61). In 2010, physician office visits for HF cost $1.8 billion. The total cost of HF care in the United States exceeds $40 billion annually, with over half of these costs spent on hospitalizations (51).

4.3. Asymptomatic LV Dysfunction

The prevalence of asymptomatic LV systolic or diastolic dysfunction ranges from 6% to 21% and increases with age (62-64). In the Left Ventricular Dysfunction Prevention study, participants with untreated asymptomatic LV dysfunction had a 10% risk for developing HF symptoms and an 8% risk of death or HF hospitalization annually

(65). In a community-based population, asymptomatic mild LV diastolic dysfunction was seen in 21% and

moderate or severe diastolic dysfunction in 7%, and both were associated with an increased risk of symptomatic HF and mortality (64).

4.4. Health-Related Quality of Life and Functional Status

HF significantly decreases health-related quality of life (HRQOL), especially in the areas of physical functioning and vitality (66, 67). Lack of improvement in HRQOL after discharge from the hospital is a

powerful predictor of rehospitalization and mortality (68, 69). Women with HF have consistently been found to have poorer HRQOL than men (67, 70). Ethnic differences also have been found, with Mexican Hispanics