Predictors of mortality after discharge in patients hospitalized with heart failure: An analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
Predictors of mortality after discharge in patients hospitalized with heart failure: An analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
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DOI：
10.1016/j.ahj.2008.04.030
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发表时间：
2008-10-01
影响因子：
4.8
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
O'Connor, Christopher M.;Abraham, William T.;Fonarow, Gregg C.
心力衰竭（HF）患者在出院后早期死亡和再住院的风险较高。我们开发的临床模型预测短期的临床结果，在广泛的患者人群出院后住院hf.Methods的有组织的程序，开始挽救生命的治疗住院患者的心力衰竭（OPTIMIZE-HF）注册表是一个全面的医院为基础的注册和性能改善计划，为患者住院治疗HF。计划在出院后60 - 90天前瞻性收集预先指定的10%样本的随访数据。对于纳入本分析的4，402例患者，在全因死亡率的逐步考克斯比例风险模型中使用了19个预先指定的潜在预测变量。结果出院后60 ~ 90天死亡率为8.6%（n = 481），再住院率为29.6%（n = 1,715）。预测早期出院后死亡率的因素包括年龄、血清肌酐、反应性气道疾病、肝脏疾病、收缩压降低、血清钠降低、入院体重降低和抑郁。出院时使用他汀类药物和β受体阻滞剂与死亡率显著降低相关。模型的C指数为0.74。死亡或再住院联合终点的最重要预测因素是入院时血清肌酐、收缩压、入院时血红蛋白、出院时使用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂和肺部疾病。从本分析中，8个确定为具有显著风险的因素被选择用于积分系统中，以预测出院后60天内的死亡风险，C-inclex为0.72。结论在因HF住院出院后的前60至90天内，存在死亡和死亡或再住院的显著风险。确定了几个因素，信号高风险患者。通过简单的算法应用这些发现可以区分低风险患者和高风险患者，后者可能受益于更密切的监测和积极的循证治疗。
Background Patients with heart failure (HF) are at high risk for mortality and rehospitalization in the early period after hospital discharge. We developed clinical models predictive of short-term clinical outcomes in a broad patient population discharged after hospitalization for HF.Methods The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry is a comprehensive hospital-based registry and performance-improvement program for patients hospitalized with HF. Follow-up data were scheduled to be prospectively collected at 60 to 90 days postdischarge in a prespecified 10% sample. For the 4,402 patients included in this analysis, 19 prespecified potential predictor variables were used in a stepwise Cox proportional hazards model for all-cause mortality. Logistic regression including 45 potential variables was used to model mortality or rehospitalization.Results The 60- to 90-day postdischarge mortality rate was 8.6% (n = 481), and 29.6% (n = 1,715) were rehospitalized. Factors predicting early postdischarge mortality include age, serum creatinine, reactive airway disease, liver disease, lower systolic blood pressure, lower serum sodium, lower admission weight, and depression. Use of statins and beta-blockers at discharge was associated with significantly decreased mortality. The C-index of the model was 0.74. The most important predictors for the combined end point of death or rehospitalization were admission serum creatinine, systolic blood pressure, admission hemoglobin, discharge use of angiotensin-converting enzyme inhibitor or angiotensin receptor blacker, and pulmonary disease. From this analysis, 8 factors identified to carry significant risk were selected for use in a point scoring system to predict the risk of mortality within 60 days after discharge, with a C-inclex of 0.72.Conclusions A substantial risk of mortality and mortality or rehospitalization is present in the first 60 to 90 days after discharge from a hospitalization for HF. Several factors were identified that signal high-risk patients. Application of these findings with a simple algorithm can distinguish patients who are low risk from those at high risk who may benefit from closer monitoring and aggressive evidence-based treatment.