Predictors of Incident Heart Failure Diagnosis Setting: Insights From the Veterans Affairs Healthcare System.
Predictors of Incident Heart Failure Diagnosis Setting: Insights From the Veterans Affairs Healthcare System.
复制标题
心力衰竭诊断设置的预测因素：来自退伍军人事务部医疗保健系统的见解。
DOI：
10.1016/j.jchf.2022.11.013
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Sandhu,AlexanderT
中科院分区：
文献类型：
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作者：
Tisdale,RebeccaL;Fan,Jun;Calma,Jamie;Cyr,Kevin;Podchiyska,Tanya;Stafford,RandallS;Maron,DavidJ;Hernandez-Boussard,Tina;Ambrosy,Andrew;Heidenreich,PaulA;Sandhu,AlexanderT
背景及早认识心力衰竭(HF)可以减少发病率，但通常只有在症状需要紧急治疗后才能诊断出心力衰竭。目的作者试图描述退伍军人健康管理局(VHA)内急性护理与门诊诊断心力衰竭的预测因素。方法作者评估了2014-2019年间VHA内急性护理(住院或急诊科)与门诊是否发生偶发心力衰竭诊断。在排除了可能由急性并发疾病引起的新发心衰后，他们确定了与诊断环境相关的社会人口学和临床变量，并使用多变量回归分析评估了130个VHA机构的变异。结果作者确定了303,632名新发心衰患者，其中160,454人(52.8%)在急性护理环境中被诊断。在前一年，44%的患者出现心力衰竭症状，11%的患者检测到利钠肽，其中88%的患者心力衰竭症状升高。住房不安全和社区社会脆弱性高的患者发生急性护理诊断的几率较高(调整后的优势比分别为1.22[95%CI：1.17~1.27]和1.17[95%CI：1.14~1.21])。较好的门诊护理质量(前两年内的血压控制和胆固醇和糖尿病监测)预示着急性护理诊断的几率较低。在调整了患者水平的危险因素后，不同机构诊断急性心力衰竭的可能性从41%到68%不等。结论许多首次诊断的心力衰竭发生在急诊环境中，特别是在社会经济脆弱人群中。较好的门诊护理与较低的急性护理诊断率相关。这些发现强调了及时诊断心力衰竭的机会，这可能会改善患者的预后。
BackgroundEarly recognition of heart failure (HF) can reduce morbidity, yet HF is often diagnosed only after symptoms require urgent treatment.ObjectivesThe authors sought to describe predictors of HF diagnosis in the acute care vs outpatient setting within the Veterans Health Administration (VHA).MethodsThe authors estimated whether incident HF diagnoses occurred in acute care (inpatient hospital or emergency department) vs outpatient settings within the VHA between 2014 and 2019. After excluding new-onset HF potentially caused by acute concurrent conditions, they identified sociodemographic and clinical variables associated with diagnosis setting and assessed variation across 130 VHA facilities using multivariable regression analysis.ResultsThe authors identified 303,632 patients with new HF, with 160,454 (52.8%) diagnosed in acute care settings. In the prior year, 44% had HF symptoms and 11% had a natriuretic peptide tested, 88% of which were elevated. Patients with housing insecurity and high neighborhood social vulnerability had higher odds of acute care diagnosis (adjusted odds ratio: 1.22 [95% CI: 1.17-1.27] and 1.17 [95% CI: 1.14-1.21], respectively) adjusting for medical comorbidities. Better outpatient quality of care (blood pressure control and cholesterol and diabetes monitoring within the prior 2 years) predicted a lower odds of acute care diagnosis. Likelihood of acute care HF diagnosis varied from 41% to 68% across facilities after adjusting for patient-level risk factors.ConclusionsMany first HF diagnoses occur in the acute care setting, especially among socioeconomically vulnerable populations. Better outpatient care was associated with lower rates of an acute care diagnosis. These findings highlight opportunities for timelier HF diagnosis that may improve patient outcomes.