Correlates of early hospital readmission or death in patients with congestive heart failure
Correlates of early hospital readmission or death in patients with congestive heart failure
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DOI：
10.1016/s0002-9149(97)00214-2
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发表时间：
1997-06-15
影响因子：
2.8
通讯作者：
Goldman, L
中科院分区：
文献类型：
--
作者：
Chin, MH;Goldman, L
在入院后存活的心力衰竭患者中，那些再次入院或出院后不久死亡的患者可能需要特别关注。因此，我们前瞻性地随访了257例非选择性地入住城市大学医院的患者，这些患者主诉呼吸急促或疲劳，入院胸片显示充血性心力衰竭，并活着出院。通过对患者和家属的调查，对医院计算机系统的回顾，以及对国家死亡指数的搜索，我们记录了死亡和再入院。出院后60天内，13名患者（5%）死亡，82名患者（32%）死亡或再次入院。使用考克斯比例风险模型，再入院或死亡的多变量相关因素是单身婚姻状况（校正风险比[HR] 2.1，95%置信区间[CI] 1.3 - 3.3），Charlson合并症指数评分（HR 1.3/点至最大4点，95% CI 1.1 - 1.6），入院时收缩压≤ 100 mm Hg（HR 2.8，95% CI 1.6 - 5.0），初始心电图上无新的ST-T波变化（HR 1.9，95%CI 1.1 - 3.3），出院时患者自我报告的依从性和临床不稳定性不相关，几乎所有按这些因素分层的患者的再入院或死亡风险至少为25%，我们的再入院或死亡的独立相关性支持了医疗和社会因素在临床下降途径中的重要性，然而，我们无法可靠地确定真正的低风险组，减少心力衰竭患者早期再入院或死亡的干预措施应针对医疗管理和社会支持的充分性，并且可能需要应用于所有入院的患者。(C)1997年，Excerpta Medica，Inc.
Among patients with heart failure who survive an admission to the hospital, those who are readmitted or die soon after discharge may warrant special attention. Therefore, we prospectively followed 257 patients admitted nonelectively to an urban university hospital, with a complaint of shortness of breath or fatigue and evidence of congestive heart failure on admission chest radiograph, who were discharged alive, Through survey of patients and families, review of the hospital computer system, and a search of the National Death Index, we recorded death and hospital readmission. Within 60 days of discharge, 13 patients (5%) died and 82 (32%) died or were readmitted to the hospital. Using Cox proportional-hazards modeling, the multivariable correlates of readmission or death were single marital status (adjusted hazard ratio [HR] 2.1,95% confidence interval [CI] 1,3 to 3.3), Charlson Comorbidity Index score (HR 1.3 per point to maximum 4 points, 95% CI 1.1 to 1.6), admission systolic blood pressure of less than or equal to 100 mm Hg (HR 2.8, 95% CI 1,6 to 5.0), and absence of new ST-T-wave changes on the initial electrocardiogram (HR 1,9, 95% CI 1.1 to 3.3), Self-reported patient compliance and clinical instability at discharge were not correlates, Almost all patients stratified by these factors had at least a 25% risk of readmission or death, Our independent correlates of readmission or death support the importance of both medical and social factors in the pathway to clinical decline, However, we could not reliably identify a truly low-risk group, Interventions to decrease early readmission or death among patients with heart failure should target both medical management and the adequacy of social support, and probably need to be applied to all admitted patients. (C) 1997 by Excerpta Medica, Inc.