泰国心力衰竭登记处全国死亡率与死因分析：最新见解
基于泰国心力衰竭登记处（THFR）2021至2023年纳入的2879例慢性心衰患者，中位随访23个月，死亡301例（10.5%），死亡率6.8/100人年。死因中49.5%为心血管，38.5%为非心血管。射血分数降低或轻度降低者心血管死亡为主，射血分数保留者非心血管死亡（尤其脓毒症）更常见。缺血病因、房颤、外周水肿、低钠血症、高肌酐及既往袢利尿剂使用为独立死亡预测因子；良好指南指导药物治疗依从性降低死亡风险。
要点
- 泰国心衰患者总体死亡率仍高，约半数死因为心血管性
- 射血分数表型影响死因分布，HFpEF患者非心血管死亡更常见
- 低钠血症、外周水肿、房颤等为可干预死亡预测因子
核心结论
- 泰国慢性心衰患者死亡率仍高，死因分布随左室射血分数表型而异，缺血性心脏病、节律管理、容量状态和电解质紊乱是潜在干预靶点
研究设计与样本
- 前瞻性队列分析，源自泰心衰登记处（THFR），纳入2021年1月至2023年12月间2879例心衰患者
- 通过电子健康记录判定死因，分为心血管、非心血管或不确定
- 采用多变量Cox比例风险模型识别全因死亡独立预测因子
主要发现
- 中位随访23个月，301例死亡（10.5%），死亡率为6.8每100人年
- 149例（49.5%）为心血管死亡，116例（38.5%）为非心血管，36例（12.0%）不确定
- HFrEF/HFmrEF患者心血管死亡高于非心血管（5.3% vs 3.9%），HFpEF患者非心血管死亡高于心血管（5.5% vs 4.1%），以脓毒症为突出
关键数值与推荐
- 缺血性病因 HR 1.34（95%CI 1.06-1.69）
- 心房颤动 HR 1.57（95%CI 1.24-2.00）
- 就诊时外周水肿 HR 2.11（95%CI 1.57-2.85）
临床怎么用
- 对心衰患者应积极识别和处理缺血病因、房颤、容量过载及电解质紊乱
- 强调指南指导药物治疗（GDMT）依从性，以降低死亡风险
- 根据射血分数表型分层管理，HFpEF需特别关注非心血管死因（如脓毒症）预防
局限性
- 部分死因归类为不确定（12.0%），可能影响死因构成比
- 登记处数据局限性（如未报告用药具体方案及依从性量化指标）
- 随访期有限（中位23个月），长期趋势需进一步观察
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Background Heart failure (HF) remains associated with high mortality worldwide despite advances in guideline-directed therapy. Aim To characterise the patterns and causes of death among Thai patients with chronic HF enrolled in a nationwide registry and to identify predictors of mortality. Methods We performed a prospective cohort analysis of 2879 HF patients enrolled in the Thai Heart Failure Registry (THFR) which has enrolled patients since 2020. The present analysis included those enrolled between January 2021 and December 2023. Causes of death were ascertained via electronic health records and adjudicated as cardiovascular (CV), non-CV or undetermined. Mortality incidence rates were calculated per 100 person-years. Multivariable Cox proportional hazards models identified independent predictors of all-cause mortality. Results Over a median follow-up of 23 months, 301 patients (10.5%) died (incidence rate 6.8 per 100 person-years). Of these, 149 (49.5%) were CV deaths, 116 (38.5%) were non-CV deaths, 36 deaths (12.0%) were undetermined. In HF with reduced ejection fraction/HF with mildly reduced ejection fraction patients, CV deaths predominated compared with non-CV mortality (5.3% vs 3.9%), whereas HF with preserved ejection fraction patients experienced higher non-CV mortality compared with CV mortality (5.5% vs 4.1%), particularly sepsis. Independent predictors of mortality included ischaemic aetiology (HR 1.34; 95% CI 1.06 to 1.69), atrial fibrillation (HR 1.57; 1.24–2.00), peripheral oedema at presentation (HR 2.11; 1.57–2.85), hyponatraemia (serum Na25 mg/dL; HR 1.56; 1.23–1.98) and prior loop diuretic use (HR 1.61; 1.21–2.14). Good guideline-directed medical therapy adherence is associated with a lower mortality despite the adjustment of confounders. Conclusions Among Thai HF patients, mortality remains high, with distinct patterns of CV versus non-CV deaths across left ventricular ejection fraction phenotypes. Targeted strategies addressing ischaemic heart disease, rhythm management, fluid status and electrolyte disturbances may reduce mortality.
引用
- Open Heart：Nationwide analysis of mortality and causes of death in heart failure: updated insights from the Thai Heart Failure Registry (THFR)
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。