注：本文由小咖机器人翻译整理

期刊来源：JAMA

文献发表时间：2023-05-16

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2804824

关键点内容如下：

问题

在不同经济发展水平的国家之间，心力衰竭的病因、治疗和结果有何不同？

调查结果

缺血性心脏病和高血压是心力衰竭最常见的原因。半数射血分数降低的患者接受了联合指南指导的药物治疗，中低收入和低收入国家的使用率最低。与高收入国家相比，中低收入和低收入国家的死亡率高出2倍以上。在低收入国家，死亡比住院更频繁，与高收入国家相比，中低收入和低收入国家与住院相关的短期死亡风险高3至5倍。

意义

这些数据可能有助于规划改善全球心力衰竭管理的方法。

摘要内容如下：

重要性

大多数关于心力衰竭（HF）的流行病学研究都是在高收入国家进行的，而来自中低收入国家的可比数据有限。

目标

研究不同经济发展水平的国家组之间在心衰病因、治疗和结果方面的差异。

研究对象

对40个高收入、中上收入、中低收入和低收入国家的23341名参与者进行了跨国HF登记，随访时间中位数为2.0年。

主要结果和措施

HF原因、HF药物使用、住院和死亡。

结果

参与者的平均（SD）年龄为63.1（14.9）岁，9119（39.1%）为女性。心衰最常见的原因是缺血性心脏病（38.1%），其次是高血压（20.2%）。射血分数降低的心衰患者联合使用β受体阻滞剂、肾素-血管紧张素系统抑制剂和盐皮质激素受体拮抗剂的比例在中上收入国家（61.9%）和高收入国家（51.1%）最高，在低收入国家（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[95%CI，7.5-8.2]），在中上收入国家为9.3（95%CI，8.8-9.9），在中低收入国家为15.7（95%CI15.0-16.4），而在低收入国家最高（19.1[95%CI17.6-20.7]）。在高收入国家（比率=3.8）和中上收入国家（比率=2.4），住院率高于死亡率，在中低收入国家相似（比率=1.1），而在低收入国家则较低（比率为0.6）。高收入国家首次入院后30天病死率最低（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心衰治疗的使用进行调整后，中低收入国家和低收入国家首次入院30天内死亡的比例风险比高收入国家高3至5倍。

结论和相关性

这项对来自40个不同国家和4个不同经济水平的心衰患者的研究显示了心衰病因、管理和结果的差异。这些数据可能有助于规划改善全球心衰预防和治疗的方法。

英文原文如下：

Key Points

Question  How do heart failure etiology, treatment, and outcomes differ between groups of countries at different levels of economic development?

Findings  Ischemic heart disease and hypertension were the most common causes of heart failure. Half of patients with reduced ejection fraction received combined guideline-directed medications, with the lowest use in lower–middle-income and low-income countries. Mortality rates were more than 2-fold higher in lower–middle-income and low-income countries compared with high-income countries. In low-income countries, deaths were more frequent than hospitalizations, and the short-term risk of death associated with a hospitalization was 3- to 5-fold higher in lower–middle-income and low-income countries compared with high-income countries.

Meaning  These data may be useful for planning approaches to improve heart failure management globally.

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 23 341 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.