Predictors of early readmission or death in elderly patients with heart failure
Predictors of early readmission or death in elderly patients with heart failure
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DOI：
10.1016/j.ahj.2010.05.007
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发表时间：
2010-08-01
影响因子：
4.8
通讯作者：
Brunner-La Rocca, Hans-Peter
中科院分区：
文献类型：
--
作者：
Muzzarelli, Stefano;Leibundgut, Gregor;Brunner-La Rocca, Hans-Peter
背景当代心力衰竭（HF）患者年龄较大，早期再住院或死亡率较高，给患者和医疗保健系统带来沉重负担。之前的研究主要针对年轻且特征不太明确的患者。我们的目的是确定老年心力衰竭患者早期再入院和死亡的预测因素。方法对参加 TIME-CHF 研究的慢性心力衰竭患者（n = 614，年龄 77 +/- 8 岁，41% 女性，左心室射血分数 35% +/- 13%）在纳入后 30 天和 90 天的再入院或死亡预测因素进行评估。在基线时获得人口统计、临床、实验室、超声心动图和社会变量，并将其纳入多变量逻辑回归分析中，以确定早期事件的预测因素。 结果 30 天 (11%) 和 90 天 (26%) 时的再入院或死亡率较高。住院原因分别为 33% 的心力衰竭、32% 的其他心血管原因和 45% 的非心血管原因。 30 天时再入院或死亡的预测因素包括心绞痛、收缩压降低、贫血、更广泛的水肿、肌酐水平升高和干咳； 90 天时有冠状动脉疾病、既往植入起搏器、高颈静脉压、肺部啰音、既往腹部手术、年龄较大和抑郁症状。 结论 老年心力衰竭患者早期再入院或死亡的情况很常见。很大一部分再入院是由于非心血管原因造成的。除了心力衰竭的临床症状外，合并症也是老年心力衰竭患者早期事件的重要预测因素。 （Am Heart J 2010；160：308-14。）
Background Contemporary heart failure (HF) patients are elderly and have a high rate of early rehospitalization or death, resulting in a high burden for both the patients and the health care system. Prior studies were focused on younger and less well-characterized patients. We aimed to identify predictors of early hospital readmission and death in elderly patients with HF.Methods Patients with chronic HF taking part in the TIME-CHF study (n = 614, age 77 +/- 8 years, 41% female, left ventricular ejection fraction 35% +/- 13%) were evaluated with respect to predictors of hospital readmission or death 30 and 90 days after inclusion. Demographic, clinical, laboratory, echocardiographic, and social variables were obtained at baseline and included in a multivariable logistic regression analysis to identify predictors of early events.Results The rate of hospital readmission or death was high at 30 (11%) and 90 days (26%). The reason for hospitalization was HF in 33%, other cardiovascular in 32%, and noncardiovascular in 45% of the cases, respectively. Predictors of readmission or death at 30 days were angina, lower systolic blood pressure, anemia, more extensive edema, higher creatinine levels, and dry cough; and at 90 days were coronary artery disease, prior pacemaker implantation, high jugular venous pressure, pulmonary rales, prior abdominal surgery, older age, and depressive symptoms.Conclusions Early hospital readmission or death was frequent among elderly HF patients. A very large proportion of readmissions were due to noncardiovascular causes. In addition to clinical signs of HF, comorbidities are important predictors of early events in elderly HF patients. (Am Heart J 2010;160:308-14.)