EARLY READMISSION OF ELDERLY PATIENTS WITH CONGESTIVE-HEART-FAILURE
EARLY READMISSION OF ELDERLY PATIENTS WITH CONGESTIVE-HEART-FAILURE
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DOI：
10.1111/j.1532-5415.1990.tb03450.x
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发表时间：
1990-12-01
影响因子：
6.3
通讯作者：
MCNAMARA, T
中科院分区：
文献类型：
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作者：
VINSON, JM;RICH, MW;MCNAMARA, T
重复住院是老年慢性病患者的主要健康问题，占所有住院医疗保险支出的四分之一。 充血性心力衰竭是老年人最常见的住院适应症之一，也与早期再住院的高发生率相关，但识别患者风险增加的变量和导致再住院的潜在补救因素的分析以前没有报道过。我们前瞻性地评估了161例70岁或以上的充血性心力衰竭住院患者。 住院死亡率为13%（n = 21）。 在存活出院的患者中，66例（47%）在90天内再次入院。 复发性心力衰竭是再入院的最常见原因，发生在38例患者（57%）中。 其他心脏疾病导致5例（8%）再次入院，非心脏疾病导致21例（32%）再次入院。 预测再入院概率增加的因素包括既往心力衰竭史、8年内4次或4次以上入院、急性心肌梗死或未控制的高血压导致的心力衰竭（均P <0.05）。 使用主观标准，25例首次再入院（38%）被判定为可能预防，10例（15%）被判定为可能预防。 导致可预防的再入院的因素包括不遵守药物（15%）或饮食（18%），出院计划（15%）或随访（20%）不足，社会支持系统失败（21%），以及症状复发时未能及时就医（20%）。患有充血性心力衰竭的老年患者的早期再住院在高达50%的病例中是可以预防的，在入院后不久就可以识别出高风险患者，进一步研究旨在减少再入院频率的非药物干预是合理的。
Repetitive hospitalizations are a major health problem in elderly patients with chronic disease, accounting for up to one fourth of all inpatient Medicare expenditures. Congestive heart failure, one of the most common indications for hospitalzation in the elderly, is also associated with a high incidence of early rehospitalization, but variables identifying patients at increased risk and an analysis of potentially remediable factors contributing to readmission have not previously been reported.We prospectively evaluated 161 patients 70 years or older that had been hospitalized with documented congestive heart failure. Hospital mortality was 13% (n = 21). Among patients discharged alive, 66 (47%) were readmitted within 90 days. Recurrent heart failure was the most common cause for readmission, occurring in 38 patients (57%). Other cardiac disorders accounted for five readmissions (8%), and noncardiac illness led to readmission in 21 cases (32%). Factors predictive of an increased probability of readmission included a prior history of heart failure, four or more admissions within the preceding 8 years, and heart failure precipitated by an acute myocardial infarction or uncontrolled hypertension (all P < .05). Using subjective criteria, 25 first readmissions (38%) were judged possibly preventable, and 10 (15%) were judged probably preventable. Factors contributing to preventable readmissions included noncompliance with medications (15%) or diet (18%), inadequate discharge planning (15%) or follow-up (20%), failed social support system (21%), and failure to seek medical attention promptly when symptoms recurred (20%).Thus, early rehospitalization in elderly patients with congestive heart failure may be preventable in up to 50% of cases, identification of high risk patients is possible shortly after admission, and further study of nonpharmacologic interventions designed to reduce readmission frequency is justified.