Mortality risk and patterns of practice in 4606 acute care patients with congestive heart failure - The relative importance of age, sex, and medical therapy

被引:109
作者
Teo, K
Montague, T
Ackman, M
Barnes, M
Taylor, C
Mansell, G
Greenwood, P
Prosser, A
Tsuyuki, R
Nilsson, C
Kornder, J
Ashton, T
McLeod, D
Morris, A
Robinson, K
Johnstone, D
Barnhill, S
Chatterton, P
Montague, P
Dowding, G
Taylor, L
Martin, S
Makinen, D
Bay, K
Yim, R
Cattellier, D
DeAlmeida, J
机构
[1] MATER MISERICORDIAE HOSP,EDMONTON,AB,CANADA
[2] ROYAL COLUMBIAN HOSP,NEW WESTMINSTER,BC,CANADA
[3] SURREY MEM HOSP,SURREY,BC,CANADA
[4] PENTICTON REG HOSP,PENTICTON,BC,CANADA
[5] VERNON JUBILEE HOSP,VERNON,BC,CANADA
[6] BONIFACE REG HOSP,WINNIPEG,MB,CANADA
[7] VICTORIA GEN HOSP,HALIFAX,NS B3H 2Y9,CANADA
[8] UNIV ALBERTA,DIV CARDIOL,EDMONTON,AB T6G 2M7,CANADA
[9] UNIV ALBERTA,EPIDEMIOL COORDINATING & RES CTR,EDMONTON,AB T6G 2M7,CANADA
关键词
D O I
10.1001/archinte.156.15.1669
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To define contemporary patterns of risk and management among patients with congestive heart failure (CHF). Methods: Cross-sectional records audit of 4606 hospitalized patients with CHF in 1992 and 1993. Results: Overall medication use was diuretics, 82%; angiotensin-converting enzyme inhibitors, 53%; nitrates, 49%; digoxin, 46%; potassium, 40%; acetylsalicylic acid, 36%; calcium antagonists, 20%; warfarin, 17%; beta-blockers, 15%; and magnesium, 10%. Angiotensin-converting enzyme inhibitors were used less frequently in women and patients 70 years or older (P<.01). Total in-hospital mortality was 19%. The most common single cause of death was CHF progression, but noncardiac causes accounted for 30% of all deaths. Logistic regression analysis revealed age 70 years or older and the use of magnesium and nitrates to be associated with increased relative risk of in-hospital mortality; angiotens-inconverting enzyme inhibitors, acetylsalicylic acid, calcium antagonists, beta-blockers, and warfarin were associated with decreased risk. Conclusions: Hospitalized patients with CHF have high all-cause mortality risk and less than optimal use of proven efficacious therapy, particularly among women and the elderly. Increased use of proven CHF therapy would likely decrease the risk of cardiac events, but the competing noncardiac risks in this patient population are high and may not be affected by improved use of efficacious cardiac therapies.
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页码:1669 / 1673
页数:5
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