Predictors of readmission among elderly survivors of admission with heart failure
Predictors of readmission among elderly survivors of admission with heart failure
复制标题
DOI：
10.1016/s0002-8703(00)90311-9
复制
发表时间：
2000-01-01
影响因子：
4.8
通讯作者：
Horwitz, RI
中科院分区：
文献类型：
--
作者：
Krumholz, HM;Chen, YT;Horwitz, RI
心力衰竭患者出院后6个月内再入院率接近50%。确定因素，以预测这些患者的再入院风险，可以帮助临床医生集中资源密集型疾病的管理工作的高危patient.Methods研究样本包括65岁或以上的患者与主要出院诊断心力衰竭谁被接纳到18康涅狄格州医院在1994年和1995年。我们从病历审查中获得了患者和临床数据。我们从医疗保险管理数据库中确定了出院后6个月内的结局，包括全因再入院、心力衰竭相关再入院和死亡。我们评估了2176例患者，包括1129例推导队列和1047例验证队列。结果32例患者和临床因素检查，4个被发现在多变量模型中与再入院显著相关。他们是入院前1年内，既往心力衰竭，糖尿病和出院时肌酐水平>2.5 mg/dL。根据风险预测因子的数量，所有结局的推导和验证集的事件发生率相似。在验证队列中，无风险预测因子的患者的全因再入院率和合并再入院率或死亡率分别为26%和31%，有1或2个风险预测因子的患者为48%和54%，59%和65%结论在老年心力衰竭患者中，很少有患者和临床因素预测出院后6个月内的再入院。虽然我们无法确定一组风险非常低的患者，但确定了一组高风险患者，为改善结局而设计的资源密集型干预措施可能是合理的。
Background Readmission rates for patients discharged with heart failure approach 50% within 6 months. Identifying factors to predict risk of readmission in these patients could help clinicians focus resource-intensive disease management efforts on the high-risk patients.Methods The study sample included patients 65 years of age or older with a principal discharge diagnosis of heart Failure who were admitted to 18 Connecticut hospitals in 1994 and 1995. We obtained patient and clinical data from medical record review. We determined outcomes within 6 months after discharge, including all-cause readmission, heart failure-related readmission, and death, from the Medicare administrative database. We evaluated 2176 patients, including 1129 in the derivation cohort and 1047 in the validation cohort.Results of 32 patient and clinical factors examined, 4 were found to be significantly associated with readmission in a multivariate model. They were prior admission within 1 year, prior heart failure, diabetes, and creatinine level >2.5 mg/dL at discharge. The event rates according to number of risk predictors were similar in the derivation and the validation sets for all outcomes. in the validation cohort, rates for all-cause readmission and combined readmission or death were 26% and 31% in patients with no risk predictors, 48% and 54% in patients with 1 or 2 risk predictors, and 59% and 65% in patients with 3 or all risk predictors.Conclusions Few patient and clinical factors predict readmission within 6 months after discharge in elderly patients with heart failure. Although we were unable to identify a group of patients at very low risk, a group of high risk patients were identified for whom resource-intensive interventions designed to improve outcomes may be justified.