Do Outcomes for Patients With Heart Failure Vary by Emergency Department Volume?
Do Outcomes for Patients With Heart Failure Vary by Emergency Department Volume?
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DOI：
10.1161/circheartfailure.113.000415
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发表时间：
2013-11-01
影响因子：
9.7
通讯作者：
Rowe, Brian H.
中科院分区：
文献类型：
--
作者：
Brar, Sandeep;McAlister, Finlay A.;Rowe, Brian H.
背景心力衰竭是一种常见的急诊科（艾德）介绍，但是否艾德量影响患者outcomes is unknown. Methods and Results回顾性队列的所有成年人提出93个ED之间的1999年和2009年与最负责任的诊断心力衰竭（n = 44 925艾德访问，平均年龄，76.4岁）。低容量ED中观察到的病例的合并症较少，住院的可能性（54.5%）低于中等（61.8%;校正的比值比[aOR] 1.16，[95%置信区间{CI} 1.10 - 1.23]）或高容量ED（73.6%; aOR，1.95 [95% CI，1.83 - 2.07]）中观察到的病例。在接受治疗和出院的患者中，低容量艾德病例在随后的7年中显示出更高的死亡/住院/艾德访视风险。（22.0%）和30天（44.9%）中等（16.3%; aOR，0.81 [95% CI，0.73 - 0.90]和35.3%; aOR，0.79 [95% CI，0.73 - 0.86]）或高容量艾德病例（13.0%; aOR，0.69 [95% CI，0.61 - 0.78]和30.2%; aOR，0.67 [95% CI，0.61 - 0.74]）。在指数艾德就诊时住院的患者中，低容量艾德病例显示出30天死亡/全因再入院的风险更高（24.3%）比在中等（21.9%; aOR，0.83 [95% CI，0.76 - 0.91]）或高容量ED（18.1%; aOR，0.77 [95%CI，0.70 - 0.85]。结论低容量ED更可能使心力衰竭患者出院回家，但低容量的艾德病例表现出更差的结局（主要是由于再入院或重复艾德就诊）。在低容量研究中心，需要采取干预措施改善急性心力衰竭的管理。
Background Heart failure is a common Emergency Department (ED) presentation but whether ED volume influences patient outcomes is unknown.Methods and Results Retrospective cohort of all adults presenting to 93 EDs between 1999 and 2009 with a most responsible diagnosis of heart failure (n=44 925 ED visits; mean age, 76.4 years). Cases seen in low-volume EDs had less comorbidities and were less likely to be hospitalized (54.5%) than those seen in medium (61.8%; adjusted odds ratio [aOR] 1.16, [95% confidence interval {CI} 1.10-1.23]) or high-volume EDs (73.6%; aOR, 1.95 [95% CI, 1.83-2.07]). Of patients treated and released, low-volume ED cases exhibited higher risk of death/hospitalization/ED visit in the subsequent 7 (22.0%) and 30 days (44.9%) than medium (16.3%; aOR, 0.81 [95% CI, 0.73-0.90], and 35.3%; aOR, 0.79 [95% CI, 0.73-0.86]) or high-volume ED cases (13.0%; aOR, 0.69 [95% CI, 0.61-0.78], and 30.2%; aOR, 0.67 [95% CI, 0.61-0.74]). Of patients hospitalized at the time of their index ED visit, low-volume ED cases exhibited a higher risk of 30-day death/all-cause readmission (24.3%) than those seen in medium (21.9%; aOR, 0.83 [95% CI, 0.76-0.91]) or high-volume EDs (18.1%; aOR, 0.77 [95% CI, 0.70-0.85]).Conclusions Low-volume EDs were more likely to discharge patients with heart failure home, but low-volume ED cases exhibited worse outcomes (driven largely by readmissions or repeat ED visits). Interventions to improve management of acute heart failure are required at low-volume sites.