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首页> 外文期刊>Circulation journal >Usefulness of combined risk stratification with heart rate and systolic blood pressure in the management of chronic heart failure - A report from the CHART-2 study
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Usefulness of combined risk stratification with heart rate and systolic blood pressure in the management of chronic heart failure - A report from the CHART-2 study

机译：风险分层与心率和收缩压联合治疗慢性心力衰竭的实用性-CHART-2研究报告

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Background: The appropriate target ranges of heart rate (HR) and systolic blood pressure (SBP) for the management of chronic heart failure (CHF) patients remain to be elucidated in a large-scale cohort study. Methods and Results: We examined 3,029 consecutive CHF patients with sinus rhythm (SR) (mean age, 67.9 years) registered in the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 Study (CHART-2; NCT00418041). There were 357 deaths (11.8%) during the median follow-up of 3.1 years. We first performed the classification and regression tree analysis for mortality, identifying SBP <89 mmHg, HR >70 beats/min and SBP <115 mmHg as the primary, secondary and tertiary discriminators, respectively. According to these, we divided the patients into low- (n=1,131), middle- (n=1,624) and high-risk (n=274) groups with mortality risk <10%, 10-20% and >20%, respectively. The low-risk group was characterized by SBP >115 mmHg and HR <70 beats/min and the high-risk group by SBP <89 mmHg regardless of HR values or SBP 89-115 mmHg and HR >76 beats/min. Multivariate Cox regression analysis revealed that the hazard ratio of all-cause death for low-, middle- and high-risk groups was 1.00 (reference), 1.48 (95% confidence interval (CI): 1.10-1.99, P=0.009) and 2.44 (95% CI 1.66-3.58, P<0.001), respectively. Subgroup analysis revealed that age ≥70 years, diabetes, or reduced left ventricular function had higher hazard ratios in the high-risk group. Conclusions: The results demonstrate the usefulness of combined risk stratification of HR and SBP in CHF patients with SR.
机译：背景：在大规模队列研究中，尚需阐明用于控制慢性心力衰竭（CHF）患者的合适的心率（HR）和收缩压（SBP）的目标范围。方法和结果：在东北区2研究（CHART-2; NCT00418041）中，我们检查了3,029名连续性CHF窦性心律（SR）患者（平均年龄，67.9岁），该患者已登记在慢性心力衰竭分析和登记中。在3.1年的中位随访期间，有357例死亡（11.8％）死亡。我们首先进行了死亡率的分类和回归树分析，分别将SBP <89 mmHg，HR> 70次/分钟和SBP <115 mmHg分别确定为主要，第二和第三者。根据这些资料，我们将患者分为死亡风险分别<10％，10-20％和> 20％的低（n = 1,131），中（n = 1,624）和高风险（n = 274）组，分别。低风险组的特征在于SBP> 115 mmHg和HR <70次/分，而高风险组的特征在于SBP <89 mmHg，而不论HR值或SBP 89-115 mmHg和HR> 76次/分。多因素Cox回归分析显示，低，中，高风险组的全因死亡风险比为1.00（参考），1.48（95％置信区间（CI）：1.10-1.99，P = 0.009）和分别为2.44（95％CI 1.66-3.58，P <0.001）。亚组分析显示，高危组中年龄≥70岁，糖尿病或左心室功能降低的危险比更高。结论：结果表明，HR和SBP合并风险分层在SR的CHF患者中是有用的。

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