The national heart failure audit for England and Wales 2008-2009
The national heart failure audit for England and Wales 2008-2009
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DOI：
10.1136/hrt.2010.209171
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发表时间：
2011-06-01
期刊：
影响因子：
5.7
通讯作者：
Dargie, Henry J.
中科院分区：
文献类型：
--
作者：
Cleland, John G. F.;McDonagh, Theresa;Dargie, Henry J.
目的了解英格兰和威尔士心力衰竭住院患者的临床特点、调查、管理和转归。方法从2008年4月至2009年3月，对英格兰和威尔士86家提供急性入院服务的医院的前10名初诊心力衰竭患者每月进行调查。结果86家医院共入选6170例患者，平均年龄78岁(智商70~85岁)，其中女性2639例(43%)。入院时，只有30%的患者在休息时呼吸困难，而43%的患者有外周水肿。75%的患者记录了超声心动图，其中90%的患者在出院时服用环状利尿剂，80%的患者使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂，50%的患者使用β-受体阻滞剂，30%的患者使用醛固酮拮抗剂。LVEF<；40%的患者更有可能接受这些药物治疗。中位住院天数为9天(IQR5-17)，住院死亡率为12%。住在普通内科病房而不是心脏病病房的患者死亡的可能性更大(HR=2.595%CI2.0to3.3，p<；0.001)，即使在调整了差异后(HR=1.99%CI1.5to2.5p<；0.001)。75岁及以上患者1年死亡率分别为26%和56%，以全科病房为主的死亡率较高(HR=1.4，95%可信区间为1.2~1.6，p<；0.001)。结论心力衰竭住院患者预后较差，调查和治疗效果欠佳。专科服务与更高的调查和治疗率以及改善的结果相关。
Objectives To obtain national data on the clinical characteristics, investigation, management and outcome of patients hospitalised with a diagnosis of heart failure.Method A survey was carried out of the first 10 patients hospitalised with a primary diagnosis of heart failure each month in 86 hospitals providing services for acute medical admissions in England and Wales from April 2008 until March 2009. The main outcome measures were rates of investigations, treatments and specialist management, length of hospital stay and mortality.Results The 86 hospitals enrolled 6170 patients with a median age of 78 years (IQR 70-85 years), including 2639 (43%) women. At admission, only 30% of patients were breathless at rest, while 43% had peripheral oedema. Echocardiograms were recorded in 75% of patients and left ventricular ejection fraction (LVEF) was 90% of patients were treated with loop diuretics at discharge, 80% with ACE inhibitors or angiotensin receptor blockers, 50% with beta-blockers and 30% with aldosterone antagonists. Patients with an LVEF < 40% were more likely to receive these agents. Median hospital stay was 9 days (IQR 5-17) and in-patient mortality was 12%. Patients admitted to general medicine rather than cardiology wards were more likely to die (HR=2.5, 95% CI 2.0 to 3.3, p < 0.001) even after adjusting for differences (HR=1.9, 95% CI 1.5 to 2.5, p < 0.001). Projected 1-year mortality below and above age 75 years was 26% and 56%, with higher rates if managed on general medicine rather than cardiology wards (HR=1.4, 95% CI 1.2 to 1.6, p < 0.001).Conclusion The prognosis of patients hospitalised with heart failure remains poor and investigation and treatment suboptimal. Specialist services are associated with higher rates of investigation and treatment and improved outcome.