Trends in heart failure care: has the incident diagnosis of heart failure shifted from the hospital to the emergency department and outpatient clinics?
Trends in heart failure care: has the incident diagnosis of heart failure shifted from the hospital to the emergency department and outpatient clinics?
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DOI：
10.1093/eurjhf/hfq185
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发表时间：
2011-02-01
影响因子：
18.2
通讯作者：
McAlister, Finlay A.
中科院分区：
文献类型：
--
作者：
Ezekowitz, Justin A.;Kaul, Padma;McAlister, Finlay A.
目标 心力衰竭 (HF) 发病率和患病率的研究经常依赖住院情况来识别患者。我们的目标是描述在门诊或急诊科 (ED) 环境中诊断出的心力衰竭患者的发病率、患病率或结果。 方法和结果 在 1999 年至 2007 年加拿大艾伯塔省单一支付医疗保健系统中 82 323 名心力衰竭患者的人群研究中，我们检查了随时间变化的趋势和临床结果。心力衰竭患者首先在普通门诊（45.7%）、专科门诊（4.0%）、急诊科（13.7%）或医院（36.6%）被诊断。从2000年到2006年，年龄标准化发病率（每10万人）从538例下降到403例，而总患病率从1585例上升到2510例。在普通门诊（6.6%）、专科门诊（7.5%）、急诊室（19.1%）和医院首次诊断的患者之间的一年死亡率存在显着差异。 （29.8%）。与急诊室 (354, IQR 313-365)、专科门诊 (365, IQR 355-365) 和普通门诊 (365, IQR: 365, IQR: 136-363) 的患者相比，住院时最初诊断的患者次年存活和出院中位天数最少 [347，四分位数范围 (IQR)：136-363] 359-365，P < 0.0001）。急诊科患者的后续就诊率以及全因、心血管或心力衰竭住院率最高。结论 随着时间的推移，与医院环境相比，更多患者被诊断为门诊患者。观察到的心力衰竭患者的发病率、患病率和结果趋势因初次诊断地点的不同而有很大差异。此外，研究急诊室心力衰竭患者应成为优先事项。
Aims Studies of heart failure (HF) incidence and prevalence frequently rely on hospitalization to identify patients. Our objective was to describe the incidence, prevalence, or outcomes for HF patients diagnosed in the outpatient or emergency department (ED) setting.Methods and results In a population-based study of 82 323 HF patients in a single-payer health-care system in Alberta, Canada from 1999 to 2007, we examined trends over time and clinical outcomes. Heart failure patients were first diagnosed in a general outpatient clinic (45.7%), a specialty outpatient clinic (4.0%), the ED (13.7%), or in hospital (36.6%). From years 2000 to 2006, the age-standardized incidence (per 100 000 population) decreased from 538 to 403, whereas the overall prevalence increased from 1585 to 2510. One-year mortality was significantly different among patients first diagnosed in a general outpatient clinic (6.6%), a specialty outpatient clinic (7.5%), ED (19.1%), and hospital (29.8%). Patients initially diagnosed at the time of hospitalization had the fewest median days alive and out of hospital [ 347, inter-quartile range (IQR): 136-363] over the next year compared with patients in the ED (354, IQR 313-365), specialty outpatient clinic (365, IQR 355-365), and general outpatient clinics (365, IQR: 359-365, P < 0.0001). Patients in the ED had the highest rate of subsequent ED visits, and all-cause, cardiovascular, or HF hospitalization.Conclusions Over time, more patients were diagnosed as outpatients compared with a hospital setting. The trends observed in incidence, prevalence, and outcomes for patients with HF differ substantially depending on the location of initial diagnosis. Additionally, efforts to study patients with HF in the ED should be a priority.