25 年来心力衰竭的年龄死亡率趋势：丹麦全国范围内的回顾性队列研究

IF 13.4 Q1 GERIATRICS & GERONTOLOGY

Lancet Healthy Longevity Pub Date : 2024-05-01 DOI:10.1016/S2666-7568(24)00029-1

Caroline Hartwell Garred MD , Morten Malmborg PhD , Mariam Elmegaard Malik MD , Deewa Zahir MD , Daniel Mølager Christensen PhD , Anojhaan Arulmurugananthavadivel MD , Prof Emil L Fosbøl PhD , Prof Gunnar Gislason PhD , Prof John J V McMurray MD , Prof Mark C Petrie MD , Charlotte Andersson PhD , Prof Lars Køber DMSc , Prof Morten Schou PhD

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引用次数: 0

摘要

背景尽管在临床试验中心力衰竭治疗的进步降低了死亡率，但仍不清楚现实生活中各年龄组的预期寿命是否有类似的改善。我们的目的是调查过去 25 年来，心衰患者的死亡率趋势是如何变化的，并按年龄组进行分层。我们使用 Kaplan-Meier 估计值和多变量 Cox 回归模型评估了心衰患者与年龄和性别匹配的无心衰对照组之间的 5 年全因死亡率风险和绝对死亡率风险差异。对五个日历期（1996-2000 年、2001-05 年、2006-10 年、2011-15 年和 2016-20 年）和三个年龄组（65 岁、65-79 岁和≥80 岁）的死亡率趋势进行了分析。死亡率从1996-2000年（66% [95% CI 65-5-66-4]）到2016-20年（43% [42-1-43-4]）明显下降，所有年龄组的结果相似（<65岁：35%[33-9-36-1]至 15%[14-6-16-3]；65-79 岁：64%[63-1-64-5]至 39% [37-6-39-6]；≥80 岁：84%[83-1-84-3]至 73% [71-7-73-9]）。调整后的死亡率支持这些关联。年轻年龄组的绝对风险差异明显下降（65 岁：29-9% [28-8-31-0] 降至 12-7% [12-0-13-4]；65-79 岁：41-1% [40-3-41] 降至 12-7%[12-0-13-4]）：25年来，各年龄组心力衰竭患者的死亡率持续下降，尽管在80岁或以上的患者中并不明显。需要进一步深入了解，以确定改善老年心力衰竭患者疾病负担的有效策略。

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Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study

Background

Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups.

Methods

Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18–95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan–Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996–2000, 2001–05, 2006–10, 2011–15, and 2016–20) and three age groups (<65 years, 65–79 years, and ≥80 years).

Findings

194 997 patients with heart failure were included. Mortality significantly decreased from 1996–2000 (66% [95% CI 65·5–66·4]) to 2016–20 (43% [42·1–43·4]), with similar results shown in all age groups (<65 years: 35% [33·9–36·1] to 15% [14·6–16·3]; 65–79 years: 64% [63·1–64·5] to 39% [37·6–39·6]; and ≥80 years: 84% [83·1–84·3] to 73% [71·7–73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8–31·0] to 12·7% [12·0–13·4] and 65–79 years: 41·1% [40·3–41·9] to 25·1% [24·4–25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9–31·3] to 28% [27·2–28·8]).

Interpretation

Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure.

Funding

None.

Translation

For the Danish translation of the abstract see Supplementary Materials section.

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来源期刊

Lancet Healthy Longevity GERIATRICS & GERONTOLOGY-

CiteScore

16.30

自引率

2.30%

发文量

192

审稿时长

12 weeks

期刊介绍： The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.