ESC 2013：心衰患者在冬季和周末的死亡率较高

　　2013年欧洲心脏病学会（ESC）心力衰竭会议上公布的一项新研究表明，充血性心力衰竭患者更有可能在冬天入院发生死亡，心力衰竭入院率和死亡率在1和2月份最高，同时在星期五、六和日入院也与死亡危险较高有关。

　　该研究入选949907例初步诊断为心力衰竭的住院患者。结果显示，在1994—2007年间，心衰患者的入院死亡率和平均住院长度分别以每年0.3% 和每年0.3天的速度呈下降趋势，但仍可观察到心衰入院和死亡率的季节性变化。因心衰而入院的时间峰在2月，而死亡率最高的月份是1月。推测原因可能是在冬天患者可能并存有诸如慢性阻塞性肺疾病（COPD）或肺炎等疾病，但即使校正这些并存疾病后，包括抑郁和物质滥用，死亡率仍在冬季保持显著的增高。

　　David Kao博士表示，住院和死亡率的季节变化似乎与温度相关，比如他观察到环境温度与院内死亡率呈负相关，即每升高4°C就与死亡危险降低3%相关（P<0.0001）。至于患者在周末死亡危险增加，他认为可能与患者未向专科医生就诊有关。入院时间也起作用，对比那些在清晨和在午后或傍晚入院的患者，死亡率约有50%的差异。医生需告知心衰患者他们的病情在冬季可能比夏季更严重，患者还应尽早入院。他还表示，患者在周末死亡率较高可能与周末医院资源如医生和患者较少有关。

Heart-failure admissions and mortality highest in winter and on weekends
Individuals with congestive heart failure are more likely to die when admitted to the hospital in the winter and on the weekend, according to the results of a new analysis. Heart-failure admissions and mortality rates were highest in January and February, while admissions on a Friday, Saturday, or Sunday were also associated with higher risks of death, report investigators.
"With heart failure, there is not as much known as there is with cardiovascular death and myocardial infarction," lead investigator Dr David Kao (University of Colorado School of Medicine, Aurora) told heartwire. "There was one previous study out of Scotland that looked at admissions and seasonal variations, and they did notice an association, as well as an increase in mortality in the winter months...