Age-Related Characteristics and Outcomes of Patients With HeartFailure With Preserved Ejection FractionJACCResearch ArticleAug 06, : 74 (5), 10.1016/j.jacc..05.052本文由“天纳”临床学术信息人工智能系统自动翻译Central Illustration
BackgroundAlthough heart failure with preserved ejection fraction (HFpEF) is considered a disease of the elderly, younger patients are not spared from this syndrome.尽管射血分数维持性心力衰竭（HFPEF）被认为是老年人的一种疾病，但年轻患者并不因此而免于这种综合征。ObjectivesThis study therefore investigated the associations among age, clinical characteristics, and outcomes in patients with HFpEF.因此，本研究调查了HFPEF患者的年龄、临床特征和预后之间的关系。MethodsUsing >利用3项大型hfpef试验（Topcat[醛固酮拮抗剂治疗成人心脏衰竭并保持收缩功能]、i-preserve[伊贝沙坦治疗心脏衰竭并保持收缩功能]和charm-preserve中左室射血分数≥45%患者的数据。[坎地沙坦-西勒克泰尔在心脏衰竭时对死亡率和发病率的降低进行评估），根据年龄将患者分为：≤55岁（n 522）、56-64岁（n 1679）、65-74岁（n 3405）、75-84岁（n=2464）和≥85岁（n=398）。本研究比较了不同年龄段的临床和超声心动图特征、死亡率和住院率、死亡模式和生活质量。ResultsYounger patients (age≤55 years) with HFpEF were more often obese, nonwhite men, whereas older patients with HFpEF were more often white women with a higher prevalence of atrial fibrillation, hypertension, and chronic kidney disease (eGFR<60ml/min/1.73m2). Despite fewer comorbidities, younger patients had worse quality of life compared with older patients (age≥85 years). Compared with patients age≤55 years, patients age≥85 years had higher mortality (hazard ratio: 6.9; 95% confidence interval: 4.2 to 11.4). However, among patients who died, sudden death was, proportionally, the most common mode of death (p<0.001) in patients age≤55 years. In contrast, older patients (age≥85 years) died more often from noncardiovascular causes (34% vs. 20% in patients age≤55 years; p<0.001).患有hfpef的年轻患者（年龄≤55岁）更常是肥胖的非白人男性，而患有hfpef的老年患者更常是房颤、高血压和慢性肾病（egfr<60 ml/min/1.73 m2）患病率较高的白人女性。尽管合并症较少，但年轻患者的生活质量较老年患者差（年龄≥85岁）。与年龄小于等于55岁的患者相比，年龄大于等于85岁的患者死亡率更高（危险比：6.9；95%置信区间：4.2-11.4）。然而，在死亡的患者中，猝死成比例地是年龄≤55岁患者最常见的死亡模式（p<0.001）。相比之下，老年患者（年龄≥85岁）死于非心血管原因的频率更高（年龄≤55岁的患者为34%对20%；P<0.001）。ConclusionsCompared with the elderly, younger patients with HFpEF were less likely to be white, were more frequently obese men, and died more often of cardiovascular causes, particularly sudden death. In contrast, elderly patients with HFpEF had more comorbidities and died more often from noncardiovascular causes. (Aldosterone Antagonist Therapy for Adults With HeartFailure and Preserved Systolic Function [TOPCAT]; ; Irbesartan in HeartFailure With Preserved Systolic Function [I-PRESERVE]; ; Candesartan Cilexetil in HeartFailure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; )与老年人相比，年轻的hfpef患者更不可能是白人，更经常是肥胖男性，更经常死于心血管疾病，特别是猝死。相比之下，老年HFPEF患者有更多的合并症，更多的死于非心血管原因。（醛固酮拮抗剂治疗成人心脏衰竭并保持收缩功能[topcat]；NCT0094302；厄贝沙坦治疗心脏衰竭并保持收缩功能[i-preserve]；NCT0095238；坎地沙坦-西勒塞治疗心脏衰竭评估死亡率和发病率的降低[保存的魅力）；NCT00634712）FootnotesDr. Jhund has received advisory board fees, speaker fees, or consultancy fees from Novartis, Vifor Pharma, Boehringer Ingelheim, and Cytokinetics; and has received research grants from Boehringer Ingelheim. Dr. Desai has served as a consultant for and received research grants from Novartis; and has served as a consultant for Abbott, AstraZeneca, Boehringer Ingelheim, Boston Scientific, DalCor Pharma, Corvidia, Regeneron, Relypsa, and Zogenix. Dr. Granger has received research grants and/or consulting/speaking fees from Abbvie, AKROS, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi-Sankyo, Espero BioPharma, the U.S. Food and Drug Administration, GlaxoSmithKline, Janssen, Medscape, Medtronic, Medtronic Foundation, Merck, National Institutes of Health, Novo Nordisk, Novartis, Pfizer, and Roche Diagnostics. Dr. Komajda has served as a consultant for Novartis, Servier, Sanofi, Merck Sharp & Dohme, and AstraZeneca; and has served as a speaker for Novartis, Servier, and Merck Sharp & Dohme. Dr. Pfeffer has received research grant support from Novartis; has served as a consultant for AstraZeneca, Corvidia, DalCor, GlaxoSmithKline, Jazz, MyoKardia, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Servier, and Takeda; and has stock options in DalCor (zero dollars). Dr. Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, Sanofi Pasteur, and Theracos; and has served as a consultant for Akros, Alnylam, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardior, Corvia, Cytokinetics, Gilead, GlaxoSmithKline, Ironwood, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, and Tenaya. Dr. Swedberg has served on the Advisory Board of AstraZeneca, Novartis, and Pfizer. Dr. Pitt has served as a consultant for Bayer, AstraZeneca, Sanofi, KBP Pharmaceuticals, Vifor, scPharmaceuticals, Cereno, and Sarfez; and has stock options in Sarfez, KBP Pharmaceuticals, and scPharmaceuticals. Dr. Lam has received research support from Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, and Vifor Pharma; and has served on the Advisory Board/Steering Committee/Executive Committee for Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, Vifor Pharma, Novartis, Amgen, Merck, Janssen Research & Development LLC, Menarini, Boehringer Ingelheim, NovoNordisk, Abbott Diagnostics, Corvia, Stealth BioTherapeautics, JanaCare, Biofourmis, and Darma. Dr. McMurray’s employer, Glasgow University, has been paid by AstraZeneca (who market dapagliflozin) for his time spent as Principal Investigator of DAPA-HF and Co-Principal Investigator of DELIVER (trials using dapagliflozin) in heart failure and meetings related to trial, as well as for travel and accommodations for these meetings; Glasgow University has also been paid by Novartis for time spent as an Executive Committee member and then Co-Principal Investigator of ATMOSPHERE, Co-Principal Investigator of the PARADIGM-HF and PARAGON-HF trials, and Executive/Steering Committee member for PARADISE-MI and PERSPECTIVE trials (with sacubitril/valsartan) and meetings/presentations related to these trials and aliskiren and sacubitril/valsartan as well as for travel and accommodations for these meetings; and he has had other clinical trial relationships with Kidney Research UK, Vifor-Fresenius Pharma, Bayer, Cardiorentis, Amgen, Oxford University/Bayer, Theracos, Abbvie, DalCor, Pfizer, Merck, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, and Novartis; all payments were made through a consultancy with Glasgow University and were not personal payments in relation to this trial/this drug. 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JACCResearch ArticleAug 06, : 74 (5), 10.1016/j.jacc..05.052
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