Understanding Hospitalization in Patients with Heart Failure
Understanding Hospitalization in Patients with Heart Failure
复制标题
DOI：
10.1016/j.amjcard.2015.07.018
复制
发表时间：
2017-02-01
影响因子：
--
通讯作者：
Souza Jr, Celso Vale
中科院分区：
文献类型：
--
作者：
Mesquita, Evandro Tinoco;Jorge, Antonio José Lagoeiro;Souza Jr, Celso Vale
因为心力衰竭(HF)伴有射血分数(HFrEF)降低和射血分数保留(HFpEF)。是不同的临床实体，具有不同的人口统计学特征，共同的结果可能以不同的比率发生。比较结果的研究一直是模棱两可的，比较资源利用的研究很少。我们使用观察性队列设计研究了6513名因心力衰竭住院的患者，他们在住院期间测量了EF，并在30天内活着出院。我们排除了677名EF临界值(41%至49%)的患者，其余的患者被归类为HFrEF(EF50%，n=3631)。对患者进行了长达1年的全因再住院、死亡率和年度医疗资源利用的跟踪调查。HFrEF和HFpEF患者的再住院率相似，但HFrEF患者在30天内死亡风险增加39%(比率比1.39，95%可信区间1.10至1.76)，一年后死亡风险增加25%(比率比1.25，95%可信区间1.12至1.41)。调整协变量后，高压性肺功能衰竭患者的年门诊量(21.5vs20.1，p=0.002)和急诊次数(3.24vs2.94，p=0.002)显著高于高血压性肺功能衰竭患者，但绝对差异很小。高住院率和高药房使用率没有区别。我们的。研究表明，患者是否患有HFrEF或HFpEF与再次住院的风险或在HF住院后一年内不耐烦的资源利用几乎没有关系。两组的死亡率都很高，但HFrEF携带者的风险更大。最后，从资源使用的角度来看，可以认为高频是一个单独的实体。(C)2015 Elsevier Inc.保留所有权利。
Because heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). are different clinical entities with differing demographic characteristics, common outcomes may occur at different rates. Comparative outcome studies have been equivocal, and studies comparing resource utilization are scant. We used an observational cohort design to study 6,513 patients hospitalized for HF who had an EF measured during the hospitalization and were discharged alive within 30 days. We excluded 677 patients with borderline EF values (41% to 49%) and categorized the remaining as HFrEF (EF 50%, n = 3,631). Patients were followed for up to 1 year for all-cause re-hospitalization and mortality and annualized medical resource utilization. Patients with HFrEF and HFpEF experienced similar adjusted incidence rates of re-hospitalization, but those with HFrEF had a 39% increased risk of mortality at 30 days (rate ratio 1.39, 95% confidence interval 1.10 to 1.76) and 25% greater risk at 1 year (rate ratio1.25, 95% confidence interval 1.12 to 1.41). After adjustment for covariates, patients with HFpEF incurred significantly more annualized outpatient visits (21.5 vs 20.1, p = 0.002) and emergency room visits (3.24 vs 2.94, p = 0.002) than those with HFrEF, but absolute differences were small. High inpatient and pharmacy utilization did not differ. Our. study suggests that whether a patient has HFrEF or HFpEF has little bearing on risk of re-hospitalization or impatient resource utilization in the year after an HF hospitalization. Both groups experienced high mortality, but those with HFrEF had greater risk. In conclusion, from the standpoint of resource use, HF can be considered a single entity. (C) 2015 Elsevier Inc. All rights reserved.