Factors contributing to the hospitalization of patients with congestive heart failure
Factors contributing to the hospitalization of patients with congestive heart failure
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DOI：
10.2105/ajph.87.4.643
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发表时间：
1997-04-01
影响因子：
12.7
通讯作者：
Goldman, L
中科院分区：
文献类型：
--
作者：
Chin, MH;Goldman, L
目标.本研究确定急性住院的诱因，并评估充血性心力衰竭患者血管紧张素转换酶抑制剂的使用情况。对1993年2月至1994年2月在某城市大学医院非选择性住院的435例患者进行了横断面图表回顾性研究，这些患者主诉呼吸急促或疲劳，并有充血性心力衰竭的证据。入院前与临床恶化相关的最常见可识别异常为急性心绞痛性胸痛（33%）、呼吸道感染（16%）、初始收缩压大于或等于180 mm Hg的未控制高血压（15%）、心率大于或等于120的房性心律失常（8%）、不依从药物（15%）或饮食（6%）; 34%的患者无法确定明确的原因。排除已经使用不同血管扩张剂或有相关禁忌症的患者后，18例（32%）入院前测量的射血分数小于或等于0.35的患者在入院时未使用血管紧张素转换酶抑制剂。干预措施，以提高依从性，控制高血压，并适当使用血管紧张素转换酶抑制剂，可以防止许多心力衰竭患者住院治疗。
Objectives. This study identifies acute precipitants of hospitalization and evaluates utilization of angiotensin-converting enzyme inhibitors in patients admitted with congestive heart failure.Methods. Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with-a complaint of shortness of breath or fatigue and evidence of congestive heart failure.Results. The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure greater than or equal to 180 mm Hg (15%), atrial arrhythmia with heart rate greater than or equal to 120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications; 18 (32%) of the patients with ejection-fractions less than or equal to 0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital.Conclusions. Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients.