Importance:In the face of an emerging heart failure (HF) epidemic, describing the association between perceived economic burden (PEB) and health care outcomes is an important step toward more equitable and achievable care. Objectives:To examine the association between PEB and risk of 1-year clinical outcomes and HF-specific health status in patients with acute decompensated HF. Design, Setting, and Participants:This prospective, multicenter, hospital-based cohort study prospectively enrolled adult patients hospitalized for acute decompensated HF at 52 hospitals in China from August 2016 to May 2018, with 1-year follow-up. Data were analyzed on June 17, 2022. Exposure:Perceived economic burden, categorized as severe (cannot undertake expenses), moderate (can almost undertake expenses), or little (can easily undertake expenses). Main Outcomes and Measures:The clinical outcomes of the study were 1-year all-cause death and rehospitalization for HF. Heart failure-specific health status was assessed by the 12-Item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Results:Among 3386 patients, median age was 67 years (IQR, 58-75 years) and 2116 (62.5%) were men. Of these patients, 404 (11.9%) had severe PEB; 2021 (59.7%), moderate PEB; and 961 (28.4%), little PEB. Compared with patients with little PEB, those with severe PEB had increased risk of 1-year mortality (hazard ratio [HR], 1.61; 95% CI, 1.21-2.13; P < .001) but not 1-year HF rehospitalization (HR, 1.21; 95% CI, 0.98-1.49; P = .07). The mean (SD) adjusted KCCQ-12 score was lowest in patients with severe PEB and highest in patients with little PEB at baseline (40.0 [1.7] and 50.2 [1.0] points, respectively; P < .001) and at each visit (eg, 12 months: 61.5 [1.6] and 75.5 [0.9] points respectively; P < .001). Patients reporting severe PEB had a clinically significant lower 1-year KCCQ-12 score compared with those reporting little PEB (mean difference, -11.3 points; 95% CI, -14.9 to -7.6 points; P < .001). Conclusions and Relevance:In this cohort study of patients with acute decompensated HF, greater PEB was associated with higher risk of mortality and poorer health status but not with risk of HF rehospitalization. The findings suggest that PEB may serve as a convenient tool for risk estimation and as a potential target for quality-improvement interventions for patients with HF.

Background: To examine the associations between cumulative depressive symptoms and subsequent mortality among patients hospitalized for acute hear failure (AHF). Methods: By using data from a prospective cohort study of patients with HF, depressive symptoms were measured by using Patient Health Questionnaire-2 (PHQ-2) at admission, 1-and 12-month after discharge. Cumulative depressive symptoms were interpreted by cumulative PHQ-2 score and cumulative times of depressive symptoms. Outcomes included subsequent 3-year all-cause and cardiovascular mortality. Results: We included 2347 patients with the median follow-up of 4.4 (interquartile range [IQR]: 4.0-5.0) years. Tertile 3 of cumulative PHQ-2 score had the highest risk of all-cause (hazard ratio [HR]: 1.47, 95 % confidence interval [CI]: 1.21-1.78) and cardiovascular mortality (HR: 1.51, 95 % CI: 1.21-1.89) compared with Tertile 1; patients with >= 2 times of depressive symptoms had the highest risk of all-cause (HR: 1.62, 95 % CI: 1.31-2.00) and cardiovascular mortality (HR: 1.60, 95 % CI: 1.25-2.05) compared with patients without any depressive symptom. Cumulative PHQ-2 score provided the highest level of incremental prognostic ability in predicting the risk of all-cause (C-statistics: 0.64, 95 % CI: 0.62-0.66) and cardiovascular mortality (C-statistics: 0.65, 95 % CI: 0.62-0.67) on the basis of Get With The Guidelines-Heart Failure score. Conclusion: Cumulative depressive symptoms were associated with the increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with HF. Repeated depressive symptom measurements could be helpful to monitor long-term depressive symptoms, identify targeted patients and perform psychological interventions and social support to improve clinical outcomes among patients with AHF.

Background Elevated hsCRP (high-sensitivity C-reactive protein) level is associated with worse prognosis among patients hospitalized for heart failure. However, the prognostic value of the long-term cumulative hsCRP remains unknown. Methods and Results We consecutively enrolled patients hospitalized for heart failure and collected their hsCRP data at admission and 1 and 12 months after discharge. Long-term cumulative hsCRP was evaluated using 2 approaches, cumulative hsCRP level quartiles and cumulative times of high hsCRP levels. Patients were classified into 4 groups by cumulative hsCRP level quartiles and cumulative times of high hsCRP levels (0- to 3-times: number of times that hsCRP levels were higher than cutoff values at admission or 1 or 12 months), respectively. Multivariable Cox models were used to assess the association of mortality with cumulative hsCRP. A total of 1281 patients were included; the median age was 64 (interquartile range, 54-73) years, and 35.4% were women. Over a 4.8-year (interquartile range, 4.2-5.1) follow-up, 374 (29.2%) patients died. Elevated long-term cumulative hsCRP level was related to higher mortality. Specifically, taking the quartile 1 as the reference, the hazard ratios (HRs) were 1.29 (95% CI, 0.92-1.81) for quartile 2, 1.62 (95% CI, 1.16-2.25) for quartile 3, and 2.38 (95% CI, 1.75-3.23) for quartile 4. Similarly, compared with the patients with 0-times (hsCRP level lower than the cutoff values in all 3 time points) of high hsCRP level, the HRs were 1.36 for 1-time (hsCRP level higher than the cutoff value in one of the 3 time points) (95% CI, 0.92-2.01), 1.95 for 2-times (hsCRP levels higher than the cutoff values in 2 of the 3 time points) (95% CI, 1.34-2.82), and 2.80 for 3-times (hsCRP levels higher than the cutoff values in the 3 time points) (95% CI, 1.97-4.00). Conclusions Increasing long-term cumulative hsCRP level was associated with worse outcomes in patients hospitalized for acute heart failure. Repeated hsCRP measurements could assist physicians in identifying patients with a high risk of death. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02878811.

Heart failure is a serious and end-stage status of various heart diseases, characterized by comparatively high rate of readmission and mortality, and has become an important public health issue. The risk of readmission and mortality following discharge of an index hospitalization are key indicators to evaluate the quality of medical care among patients with acute heart failure. Therefore, it is important to carry out risk prediction research for patients with acute heart failure, quantify the disease risk, perform risk stratification, optimize clinical decision-making, elevate patients' quality of life and prognosis, and comprehensively improve the medical quality of acute heart failure. During the past 20 years, foreign researchers have developed dozens of models to predict the risk of acute heart failure readmission and mortality, and Chinese researchers have also developed up to 10 models applicable to the Chinese population. However, there is no recommended risk prediction model for acute heart failure in current clinical guidelines across China. In this report, we aim to introduce the major models for predicting the risk of acute heart failure readmission and mortality from home and abroad, focus on putting forward limitations of established models, and initiating potential directions for future studies from the following aspects: integrate multi-source data, mine emerging biomarkers, establish polygenic risk scores, optimize machine learning methods, promote flexible adjustment, and broaden approaches that applicable for various scenarios. Accordingly, this study will help facilitate domestic research in predicting the risk of readmission and mortality among patients hospitalized for acute heart failure.

BACKGROUND:Clinical outcomes are poor if patients with acute heart failure (AHF) are discharged with residual congestion in the presence of renal dysfunction. However, there is no single indication to reflect the combined effects of the two related pathophysiological processes. We, therefore, proposed an indicator, congestion and renal index (CRI), and examined the associations between the CRI and one-year outcomes and the incremental prognostic value of CRI compared with the established scoring systems in a multicenter prospective cohort of AHF.METHODS:We enrolled AHF patients and calculated the ratio of thoracic fluid content index divided by estimated glomerular filtration rate before discharge, as CRI. Then we examined the associations between CRI and one-year outcomes.RESULTS:A total of 944 patients were included in the analysis (mean age 63.3 ± 13.8 years, 39.3% women). Compared with patients with CRI ≤ 0.59 mL/min per kΩ, those with CRI > 0.59 mL/min per kΩ had higher risks of cardiovascular death or HF hospitalization (HR = 1.56 [1.13-2.15]) and all-cause death or all-cause hospitalization (HR = 1.33 [1.01-1.74]). CRI had an incremental prognostic value compared with the established scoring system.CONCLUSIONS:In patients with AHF, CRI is independently associated with the risk of death or hospitalization within one year, and improves the risk stratification of the established risk models.

Background Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long‐term individual trajectories of health status in patients with acute HF after discharge. Methods and Results We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire–12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire–12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) (P<0.05). Compared with the pattern of persistently good, slowly improving (hazard ratio [HR], 1.50 [95% CI, 1.06–2.12]), moderately regressing (HR, 1.92 [1.43–2.58]), severely regressing (HR, 2.26 [1.54–3.31]), and persistently poor (HR, 2.34 [1.55–3.53]) were associated with increased risks of all‐cause death. Conclusions One‐fifth of 1‐year survivors after hospitalization for HF experienced unfavorable health status trajectories and had a substantially increased risk of death during the following years. Our findings help inform the understanding of disease progression from a patient perception perspective and its relationship with long‐term survival. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT02878811.

目的:分析急性心力衰竭(心衰)住院患者出院后2年内的死亡情况、死因及死亡影响因素.方法:从重大慢病国家注册登记研究心衰前瞻队列研究中选取2016年8月至2018年5月全国52家医院的4582例急性心衰住院患者,按左心室射血分数(LVEF)分为射血分数降低的心衰(HFrEF,LVEF<40％,n=1999)、射血分数轻度降低的心衰(HFmrEF,40％≤LVEF<50％,n=885)、射血分数保留的心衰(HFpEF,LVEF≥50％,n=1698)三类.于患者出院后1、6、12、24个月随访,收集死亡与死因信息,分析心衰患者出院后2年内的死亡情况、死因及死亡影响因素.结果:患者中位年龄为67(57,75)岁,37.2％为女性.出院后2年内,1233例(26.9％)患者死亡,其中心血管死亡744例(16.2％),非心血管死亡170例(3.7％),死因不明319例(7.0％).多因素Cox分析显示,HFmrEF、HFpEF患者2年内全因死亡(分别为:HR=0.69,95％CI:0.59～0.81;HR=0.58,95％CI:0.51～0.67)和心血管死亡(分别为:HR=0.72,95％CI:0.59～0.88;HR=0.48,95％CI:0.40～0.58)风险均低于HFrEF患者(P均<0.01).在三类心衰患者中,心血管死亡均为最主要的死因,HFrEF患者中心血管死亡比例高于HFmrEF患者和HFpEF患者(19.9％vs.16.5％vs.11.8％,P<0.01).除年龄、合并症等常见临床因素外,生活质量较差、抑郁、认知功能障碍等以患者为中心的健康状态相关因素也与全因死亡和心血管死亡风险增加有关.结论:约四分之一的急性心衰患者在出院后2年内死亡,心血管原因为主要死因,HFrEF患者的长期死亡风险高于HFmrEF患者和HFpEF患者.常见临床因素和以患者为中心的健康状态相关因素均与患者出院后死亡有关.

目的:分析不同左心室射血分数(LVEF)心力衰竭(心衰)患者的健康相关生活质量(HRQoL)变化趋势及差异.方法:基于重大慢病国家注册登记研究心衰前瞻性队列连续入选 2016 年 8 月至 2018 年 5 月全国 52 家医院≥18岁、因急性心衰入院的 2 222 例患者,均完成入院 48 h内及出院 1 个月、6 个月、1 年随访时堪萨斯城心肌病问卷-12(KCCQ-12)调查.纳入患者按LVEF分为射血分数降低的心衰(HFrEF,LVEF<40％)、射血分数轻度降低的心衰(HFmrEF,40％≤LVEF<50％)和射血分数保留的心衰(HFpEF,LVEF≥50％),采用KCCQ-12 评分定量评估三类心衰患者的HRQoL.结果:2 222 例心衰住院患者的中位年龄 65(55,74)岁,36.3％为女性,HFrEF患者 942 例(42.4％),HFmrEF患者 470 例(21.2％),HFpEF患者 810 例(36.5％).与HFrEF患者相比,HFmrEF、HFpEF患者的年龄较大,女性比例较高(P均<0.017);HFmrEF、HFpEF 患者中合并高血压、冠心病、心房颤动、贫血的患者比例均高于 HFrEF 患者(P均<0.017).与基线相比,三类心衰患者出院 1 个月、6 个月、1 年时的KCCQ-12 评分均增加(P均<0.01),且KCCQ-12 评分随时间变化趋势相似,均在 1 个月时大幅度增加,在 6 个月时小幅度增加,此后 6 个月趋于稳定;HFpEF患者出院 1 个月、6 个月、1 年时的KCCQ-12 评分均低于HFrEF、HFmrEF患者,HFmrEF患者的KCCQ-12评分低于HFrEF患者,差异均有统计学意义(P均<0.01).多因素Logistic回归分析显示,合并高血压、慢性肾脏病、HFpEF、NYHA心功能分级Ⅲ级和Ⅳ级的患者出院后 1 年HRQoL差的可能性更大(P均<0.05).结论:HFpEF患者年龄较大,合并症较多.在出院后 1 年存活的患者中,HFrEF、HFmrEF、HFpEF患者的HRQoL均在1个月随访时较基线明显改善,6个月小幅度改善,然后趋于稳定;出院后,HFrEF 患者的HRQoL相对较好,HFpEF患者较差,HFmrEF患者介于两者之间.

煤炭开采过程中,由于强矿压的作用会引起各种复杂的动力现象,影响采矿作业的正常进行,威胁煤矿的安全生产,探索新的技术途径控制特厚煤层开采中强矿压难题势在必行.以大同塔山煤矿为工程研究对象,运用三维计算机模拟、实验室研究和工业性试验研究,分析多煤层开采时,解放层山4#煤层采动后对3-5#煤层开采的影响,研究利用解放层开采区域治理大结构顶板强矿压技术,并分析该技术的适用条件和作用,获得基于解放层开采区域的特厚综放大结构强矿压顶板运动规律、矿压显现规律及控制措施等,为特厚煤层综放大结构顶板强矿压开采支护方式选择、巷道布置形式、支架选型以及支架控制技术参数的确定提供依据,为类似条件下的煤层开采开创了新的技术途径.

Background The chronic effects of fine particulate matter (PM2.5) at high concentrations remains uncertain. We aimed to examine the relationship of long-term PM2.5 exposure with all-cause and the top three causes of death (cardiovascular disease [CVD], cancer, and respiratory disease), and to analyze their concentration-response functions over a wide range of concentrations. Methods We enrolled community residents aged 35-75 years from 2014 to 2017 from all 31 provinces of the Chinese Mainland, and followed them up until 2021. We used a long-term estimation dataset for both PM2.5 and O-3 concentrations with a high spatiotemporal resolution to assess the individual exposure, and used Cox proportional hazards models to estimate the associations between PM2.5 and mortalities. Findings We included 1,910,923 participants, whose mean age was 55.6 +/- 9.8 years and 59.4% were female. A 10 mu g/m(3) increment in PM2.5 exposure was associated with increased risk for all-cause death (hazard ratio 1.02 [95% confidence interval 1.012-1.028]), CVD death (1.024 [1.011-1.037]), cancer death (1.037 [1.023-1.052]), and respiratory disease death (1.083 [1.049-1.117]), respectively. Long-term PM2.5 exposure nonlinearly related with all-cause, CVD, and cancer mortalities, while linearly related with respiratory disease mortality. Interpretation The overall effects of long-term PM2.5 exposure on mortality in the high concentration settings are weaker than previous reports from settings of PM2.5 concentrations < 35 mu g/m(3). The distinct concentration-response relationships of CVD, cancer, and respiratory disease mortalities could facilitate targeted public health efforts to prevent death caused by air pollution.

Background:Inflammation contributes to the progression of heart failure (HF). However, long-term inflammatory trajectories and their associations with outcomes in patients with acute HF remain unclear. Methods:Data was obtained from the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, and high-sensitivity C-reactive protein (hsCRP) was used to reflect the inflammatory level. Only patients who survived over 12-month and had hsCRP data at admission, 1-, and 12-month after discharge were included. The latent class trajectory modeling was used to characterize hsCRP trajectories. Multivariable Cox regression models were used to explore the association between hsCRP trajectories and following mortality. Results:Totally, 1281 patients with a median 4.77 (interquartile range [IQR]: 4.24-5.07) years follow-up were included. The median age was 64 years (IQR: 54-73 years); 453 (35.4%) were female. Four distinct inflammatory trajectories were characterized: persistently low (n = 419, 32.7%), very high-marked decrease (n = 99, 7.7%), persistently high (n = 649, 50.7%), and persistently very high (n = 114, 8.9%). Compared with the persistently low trajectory, the all-cause mortality was increased in a graded pattern in the persistently high (hazard ratio [HR]: 1.59, 95% confidence interval [CI]: 1.23-2.07) and persistently very high (HR: 2.56, 95% CI: 1.83-3.70) trajectories; nevertheless, the mortality was not significantly increased in very high-marked decrease trajectory (HR: 0.94, 95% CI: 0.57-1.54). Conclusion:Four distinct inflammatory trajectories were identified among patients with acute HF who survived over 12-month. Patients with persistently high and very high trajectories had significantly higher mortality than those with the persistently low trajectory.

Background The age‐related trends in the predictive ability of carotid intima‐media thickness (CIMT) for cardiovascular risk remain unclear. We aimed to identify the age‐related trends in the predictive value of CIMT for cardiovascular death. Methods and Results In a prospective cohort of adults aged 35 to 75 years without history of cardiovascular disease who were enrolled between 2014 and 2020, we measured CIMT at baseline and collected the vital status and cause of death. We divided the study population into 4 age groups (35–44, 45–54, 55–64, and 65–75 years). Competing risk models were fitted to estimate the associations between CIMT and cardiovascular death. The added values of CIMT in prediction were assessed by the differences of the Harrell's concordance index and the net reclassification improvement index. We included 369 478 adults and followed them for a median of 4.7 years. A total of 4723 (1.28%) cardiovascular deaths occurred. After adjusting for the traditional risk factors, the hazard ratios for CIMT mean per SD decreased with age, from 1.27 (95% CI, 1.17–1.37) in the 35 to 44 years age group to 1.14 (95% CI, 1.10–1.19) in the 65 to 75 years age group ( P for interaction <0.01). Meanwhile, the net reclassification improvement indexes for CIMT mean were attenuated with age, from 22.60% (95% CI, 15.56%–29.64%) in the 35 to 44 years age group to 7.00% (95% CI, −6.82% to 20.83%) in the 65 to 75 years age group. Similar results were found for maximum CIMT in all age groups. Conclusions CIMT may improve cardiovascular risk prediction in the young and middle‐aged populations, rather than those aged ≥55 years.

Abstract Aims This study aimed to evaluate the cumulative high‐sensitivity cardiac troponin T (hs‐cTNT) from admission to 12 months after discharge and its association with mortality after 12 months among patients with acute heart failure (HF). Methods We used data from the China Patient‐Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p‐HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. We included patients who survived within 12 months and had hs‐cTNT data at admission (within 48 h of admission) and 1 and 12 months after discharge. To evaluate the long‐term cumulative hs‐cTNT, we calculated cumulative hs‐cTNT levels and cumulative times of high hs‐cTNT level. Patients were divided into groups according to the quartiles of cumulative hs‐cTNT levels (Quartiles 1–4) and cumulative times of high hs‐cTNT levels (0–3 times). Multivariable Cox models were constructed to examine the association of cumulative hs‐cTNT with mortality during the follow‐up period. Results We included 1137 patients with a median age of 64 [interquartile range (IQR), 54–73] years; 406 (35.7%) were female. The median cumulative hs‐cTNT level was 150 (IQR, 91–241) ng/L*month. Based on the cumulative times of high hs‐cTNT levels, 404 (35.5%) patients were with zero time, 203 (17.9%) with one time, 174 (15.3%) with two times, and 356 (31.3%) with three times. During a median follow‐up of 4.76 (IQR, 4.25–5.07) years, 303 (26.6%) all‐cause deaths occurred. The increasing cumulative hs‐cTNT level and cumulative times of high hs‐cTNT level were independently associated with excess all‐cause mortality. Compared with Quartile 1 group, Quartile 4 had the highest hazard ratio (HR) of all‐cause mortality [4.14; 95% confidence interval (CI): 2.51–6.85], followed by Quartile 3 (HR: 3.35; 95% CI: 2.05–5.48) and Quartile 2 (HR: 2.47; 95% CI: 1.49–4.08) groups. Similarly, taking the patients with zero time of high hs‐cTNT level as the reference, the HRs were 1.60 (95% CI: 1.05–2.45), 2.61 (95% CI: 1.76–3.87), and 2.86 (95% CI: 1.98–4.14) in patients who had one, two, and three times of high hs‐cTNT level, respectively. Conclusions Elevated cumulative hs‐cTNT from admission to 12 months after discharge was independently associated with mortality after 12 months among patients with acute HF. Repeated measurements of hs‐cTNT after discharge may help monitor the cardiac damage and identify patients with high risk of death.

CO,CH 4 and other toxic and harmful gases exist in the overlying goaf of multi-coal seam mining.Whether the harmful gases can be released and cause disaster is a problem that needs to be solved in the safety production of the underlying coal seam threatened by multi-coal seam mining.Aiming at the problem of harmful gas leakage in the goaf of overlying Jurassic coal seam in Datong mining area,the development height of gas-conducting fissure channel in No.3-5 coal seam is analyzed theoretically by using the theory of key strata and material mechanics,and it is determined that the mining of Carboniferous coal seam will cause the connection between the goaf of double system.Combined with the multi-field coupling numerical simulation method,the analysis of the leakage characteristics of the harmful gas in the Jurassic goaf is carried out.It is determined that when the pressure difference between the two systems is greater than400 Pa and the fracture channel is greater than 0.4m,the harmful gas in the overlying Jurassic goaf will be discharged and may cause disaster.The research results can provide a theoretical basis for the prevention and control of harmful gas interference in similar multi-coal seam mining.

Objective:To describe the prevalence of home blood pressure monitoring and analyze the factors influencing regular blood pressure monitoring among elderly uncontrolled hypertensive patients in Central and Western China.Methods:It was a cross-sectional study, which enrolled hypertensive patients aged over 60 years with office blood pressure ≥140/90 mmHg (1 mmHg=0.133 kPa) from September 2019 to July 2020 in 72 hospitals in Central and Western China. Patients completed the electronic questionnaires, and were divided into regular and irregular home blood pressure monitoring groups. The proportion of patients using different types of sphygmomanometers and the percentage of patients with regular home blood pressure monitoring (at least weekly) were explored. The generalized linear mixed model was used to define the influencing factors of regular home blood pressure monitoring.Results:A total of 3 857 patients were included in this study. Age was 67(64,71) years old and there were 2 163 males (56.1%). Overall, sphygmomanometer was available at home for 3 044(78.9%) patients, 2 168(56.2%) patients conducted regular home blood pressure monitoring. Among the patients with a sphygmomanometer at home, 2 370(77.9%) of the sphygmomanometers were upper arm electronic device. Older age, higher income, longer history of hypertension, multiple antihypertensive medications and awareness of diagnostic criteria of hypertension and hypertension complications were associated with a higher prevalence of regular home blood pressure monitoring (all P<0.05). Conclusions:Among the elderly hypertensive patients with uncontrolled blood pressure in Central and Western China, there is a relatively high prevalence of home sphygmomanometer ownership and regular monitoring. Age, family income, history of hypertension, number of antihypertensive drugs and knowledge of hypertension are the influencing factors of regular home blood pressure monitoring in this population.

目的:描述心力衰竭住院患者抑郁状况,探索抑郁的影响因素及其与1年结局的关联性.方法:本研究数据来源于重大慢性病国家注册登记研究心力衰竭前瞻队列,对41家医院的582例心力衰竭住院患者进行了调查,以问卷和住院病历信息提取的方式获取基线信息,患者出院后进行为期1年的随访.采用患者健康问卷(PHQ)-8评估患者抑郁情况,PHQ-8评分≥10分被定义为抑郁.采用Logistic回归模型分析抑郁的影响因素,采用Cox风险比例回归模型评估抑郁与1年全因死亡之间的关联.结果:43.0％的心力衰竭住院患者合并抑郁.女性较男性抑郁风险增加82％(OR=1.82,95％CI:1.22～2.72,P<0.01);合并心肌梗死病史者较未合并者抑郁风险增加63％(OR=1.63,95％CI:1.06～2.52,P=0.03);与NYHA心功能Ⅱ级患者相比,NYHA心功能Ⅳ级患者抑郁风险增加32％(OR=1.32,95％CI:1.01～1.72,P=0.04).Cox回归分析结果显示,院内合并抑郁的心力衰竭患者较不合并者1年全因死亡风险增加92％(HR=1.92,95％CI:1.29～2.87,P<0.01).结论:心力衰竭住院患者中超出四成合并抑郁,这些患者1年内全因死亡风险较不合并者增加近一倍.建议对心力衰竭住院患者进行抑郁筛查,并采取针对性的干预,或有助于降低长期死亡风险.

目的:分析不同左心室射血分数(LVEF)心力衰竭(心衰)住院患者临床特征、院内诊疗及6个月结局差异.方法:从重大慢病国家注册登记研究心衰前瞻队列研究中选取2016年8月至2017年7月全国50家医院连续纳入的18岁以上心衰住院患者,根据LVEF分为射血分数减低的心衰(HFrEF,LVEF<40％)组、射血分数中间值的心衰(HFmrEF,40％≤LVEF<50％)组、射血分数保留的心衰(HFpEF,LVEF≥50％)组.比较三组患者的临床特征、院内治疗情况和6个月全因死亡风险.结果:共入选2781例心衰住院患者,中位年龄67(57,75)岁,37.9％为女性;HFrEF组1031例(37.1％),HFmrEF组643例(23.1％),HFpEF组1107例(39.8％).HFmrEF组患者中位年龄(67岁)高于HFrEF组(62岁),但低于HFpEF组(71岁),HFpEF组的女性比例(51.4％)高于HFrEF组(23.9％)和HFmrEF组(37.3％),差异均有统计学意义(P均<0.017).全部心衰患者中合并比例最高的疾病为高血压(56.4％)、心房颤动(29.5％)和糖尿病(28.3％).HFmrEF组和HFpEF组高血压(HFmrEF组vs.HFpEF组vs.HFrEF组:60.5％vs.63.0％vs.46.8％)和心房颤动(HFmrEF组vs.HFpEF组vs.HFrEF组:32.2％vs.35.6％vs.21.3％)的合并比例均明显高于HFrEF组(P均<0.017).HFmrEF组住院期间血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、醛固酮受体拮抗剂和β受体阻滞剂的使用率分别为66.4％、85.1％、74.5％,HFpEF组分别为55.2％、76.4％、64.1％,两组均低于HFrEF组(75.8％、90.1％、81.2％,P均<0.017).HFmrEF组(HR=0.696,95％CI:0.510～0.951,P=0.02)和HFpEF组(HR=0.493,95％CI:0.366～0.665,P<0.01)患者6个月死亡风险均低于HFrEF组患者.结论:本研究中,HFpEF患者和HFmrEF患者在全部心衰住院患者中分别占四成和近四分之一.HFpEF患者和HFmrEF患者的临床特征与HFrEF患者不同,治疗模式相似,出院6个月死亡风险均低于HFrEF患者.

Objectives Little is known about contemporary characteristics and management of valvular heart disease (VHD) in China. This study aimed to examine the clinical characteristics, aetiology and type of VHD, interventions and in-hospital outcomes of patients with VHD hospitalised in China. Methods We used a two-stage random sampling design to create a nationally representative sample of patients with VHD hospitalised in 2015 in China and included adult patients with mild, moderate or severe VHD. We abstracted data from medical records, including echocardiogram reports, on patient characteristics, aetiology, type and severity of VHD, interventions and in-hospital outcomes. We weighted our findings to estimate nationally representative hospitalisations. We performed multivariable logistic regression analysis to identify factors associated with valve intervention. Results In 2015, 38 841 patients with VHD were hospitalised in 188 randomly sampled hospitals, representing 662 384 inpatients with VHD in China. We sampled 9363 patients, mean age 68.7 years (95% CI 42.2 to 95.2) and 46.8% (95% CI 45.8% to 47.8%) male, with an echocardiogram. Degenerative origin was the predominant aetiology overall (33.3%, 95% CI 32.3% to 34.3%), while rheumatic origin was the most frequent aetiology among patients with VHD as the primary diagnosis (37.4%, 95% CI 35.9% to 38.8%). Rheumatic origin was also the most common aetiology among patients with moderate or severe VHD (27.3%, 95% CI 25.6% to 29.0% and 33.6%, 95% CI 31.9% to 35.2%, respectively). The most common VHD was mitral regurgitation (79.1%, 95% CI 78.2% to 79.9%), followed by tricuspid regurgitation (77.4%, 95% CI 76.5% to 78.2%). Among patients with a primary diagnosis of severe VHD who were admitted to facilities capable of valve intervention, 35.6% (95% CI 33.1% to 38.1%) underwent valve intervention during the hospitalisation. The likelihood of intervention decreased significantly among patients with higher operative risk. Conclusions Among patients with VHD hospitalised in China, the predominant aetiology was degenerative in origin; among patients with moderate or severe VHD, rheumatic origin was the most common aetiology. Targeted strategies and policies should be promoted to address degenerative VHD. Patients with severe VHD may be undertreated, particularly those with high operative risk.

目的:描述并比较全球及我国近五年(2016～2020年)发表心血管领域研究论著的数量、质量和影响,评价我国整体和主要医院在心血管疾病防治领域的科研产出及影响力.方法:在PubMed检索全球2016年1月1日至2020年12月31日发表的心血管疾病防治领域研究论著,比较不同国家和机构的研究论著的数量与基本科学指标数据库(essential science indicators,ESI)高引用量论著等质量指标,并描述其研究主题分布.结果:2016～2020年,我国共发表心血管疾病防治领域研究论著26711篇,仅次于美国(48840篇),其中高引用量论著与中国科学院一区期刊的论著占比均在全球排名第8.我国研究者牵头的被欧美权威临床指南引用的论著有66篇,排名第7.全球发表研究论著数量最多的20家医院有5家来自我国,其中最高的排名第5.我国高引用量论著、中国科学院一区期刊论著数量最高的医院分别排第12、16名,牵头被欧美指南引用的研究论著数量最多的医院排第14名.结论:我国心血管疾病防治领域的研究论著数量已经稳居全球第2名,而论著的质量和影响距离领先国家仍有差距,国内领先医院的引领作用尚待加强.

BACKGROUND:Preoperative frailty is associated with poor outcomes in major surgery. Postoperative delirium is common after neurosurgery. To date, the association of preoperative frailty with postoperative delirium after neurosurgery has not been established. We aimed to determine the association between preoperative frailty and postoperative delirium in patients undergoing elective brain tumor resection. METHODS:We retrospectively analyzed the data of a prospective cohort, consecutively enrolling adult patients admitted to the intensive care unit after elective craniotomy for brain tumor resection under general anesthesia in a tertiary hospital in China from March 1, 2017 to February 2, 2018. Preoperative frailty was evaluated using the modified frailty index. The primary outcome was postoperative delirium, assessed using the Confusion Assessment Method for the Intensive Care Unit. Univariate and multivariable regression analyses were performed to examine the association. RESULTS:659 patients met inclusion criteria for our analysis. There were 398 (60.4%) non-frail (modified frailty index = 0), 237 (36.0%) pre-frail (modified frailty index = 1-2), and 24 (3.6%) frail (modified frailty index ≥ 3) patients. Of these, 124 (18.8%) developed postoperative delirium. In adjusted analyses, frailty was independently associated with postoperative delirium (odds ratio 1.7, 95% confidence interval 1.0-2.7, P = .032). Frail patients had longer length of hospital stay and higher total costs than non-frail patients. CONCLUSION:Preoperative frailty is associated with postoperative delirium, length of hospital stay, and total costs in patients undergoing elective brain tumor resection. Preoperative frailty assessment and appropriate management strategies should be involved in the perioperative management of postoperative delirium.