以健康族群和急性心衰竭病患為樣本的心跳軌跡與不良預後研究

Abstract

背景與目標：根據流行病學的資料，心跳過快已被證實是臨床上不良預後的重要預測因子。本研究的目的是針對社區中的一般大眾和有急性心臟衰竭的病人，統合多個時間點的心跳資料，進而把心跳軌跡變化類似的個體進行分組，討論心跳軌跡和臨床上不良預後的關聯。 方法：在第一個研究以社區族群為主的世代研究，在1990年到2002年間，共有3434個受試者接受了最多4次的心跳測量，研究的主要目標是全死因死亡，次要目標是心血管疾病。第二個研究是以急性心衰竭病患為主，台灣心臟學會於2013年二月到2015年十月，共收錄了1509位病人，在住院，出院，出院後第六和第十二個月分別追蹤病人的心跳，研究的主要目標是全死因死亡，次要目標是心衰竭再住院。利用群組化軌跡模式把心跳變化型態類似的個體分組，再針對不同的臨床結果進行存活分析。同時也使用之前文獻中使用過的心跳參數，包含單點的心跳數值，或是兩點間心跳變化等，來和群組化軌跡模式做對照。 結果：以群組化軌跡模式所得到的組別，在社區研究中，可以見到心跳較快會隨時間增加的組別相比心跳穩定的組別，全死因死亡率明顯較高，其風險比為1.8，95%信賴區間為1.18-2.76。至於急性心臟衰竭的病人，出院後的六個月內心跳趨勢持續上升者，相較於心跳穩定的病人，全死因死亡和心衰竭再住院率會較高，其風險比為3.32 (95%信賴區間為1.31-8.40)和1.29 (95%信賴區間為1.05-1.57)。 結論：對於重複測量心跳的研究，心跳的趨勢變化研究展現了其實用性，在我們的研究中闡明了心跳趨勢和不良預後之間的相關性。

Background and Objectives: Epidemiologic studies have demonstrated the elevated heart rate to be an indicator of adverse clinical outcomes. We tried to study the association of different heart rate trajectories with the adverse outcomes in community-based population and in patients with acute heart failure. Methods: For community-based population, 3434 participants were recruited with four repeated heart rate measurement between 1990 and 2002. The primary outcome was all-cause mortality, and the secondary outcome was the cardiovascular disease. For patients with acute heart failure, a total of 1509 patients were enrolled in Taiwan Society of Cardiology-the heart failure with reduced ejection fraction registry, beginning in Feb, 2013 to Oct, 2015. Heart rate was measured at admission, at discharge, 6 and 12 months post-discharge. The primary outcome was all-cause mortality and secondary outcome was heart failure re-admission. Group-based trajectory modeling analysis was conducted to stratify participants with repeated heart rate measurements. Results: In community based cohort study, those with markedly increased heart rate pattern would have higher risk of all-cause mortality than participants with stable pattern. The adjusted hazard ratios of all-cause mortality for participants with a markedly increased trajectory pattern were 1.80 (95% CI, 1.18-2.76) compared with those with a stable trajectory pattern. In patients with acute heart failure, patients with high-increasing trajectory pattern in 6 months had a higher risks of all-cause mortality and heart failure re-admission with adjusted hazard ratio 3.32 (95% CI, 1.31-8.40) and 1.29 (95% CI, 1.05-1.57) compared with those with low-stable trajectory. Conclusions: Trajectory patterns demonstrated the utility of repeated heart rate measurements and elucidated their associations with adverse outcomes.