Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry.
Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry.
复制标题
心力衰竭住院患者的转诊和出院后心脏康复利用模式：来自 GWTG-HF 登记处的分析。
DOI：
10.1161/circheartfailure.122.010144
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Pandey,Ambarish
中科院分区：
文献类型：
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作者：
Keshvani,Neil;Subramanian,Vinayak;Wrobel,ChristopherA;Solomon,Nicole;Alhanti,Brooke;Greene,StephenJ;DeVore,AdamD;Yancy,ClydeW;Allen,LarryA;Fonarow,GreggC;Pandey,Ambarish
背景2014年，射血分数降低的心力衰竭患者的心脏康复（CR）覆盖范围扩大，但当代转诊和参与率仍不清楚。方法纳入美国心脏协会指南-心力衰竭登记册中2010年至2020年因射血分数降低的心力衰竭（≤35%）住院的患者，CR转诊状态被描述为是、否或未捕获。在整个队列中评估 CR 转诊的时间趋势。使用多变量调整逻辑回归模型评估患者和医院层面 CR 转诊的预测因素。此外，对年龄 > 65 岁、具有可用医疗保险管理索赔数据且出院后 6 周内临床稳定的患者进行 CR 转诊和转诊 1 年内 CR 的比例利用率进行了评估。最后，使用多变量调整 Cox 模型评估 CR 转诊与 1 年死亡和再入院风险之间的关系。 结果 在 69,441 名符合 CR 资格的射血分数降低的心力衰竭患者（中位年龄 67 岁；33% 女性；30% 黑人）中，17,076 例（24.6%）转诊至 CR，转诊率从 2010 年的 8.1% 上升到2020 年为 24.1%（Ptrend<0.001）。在出院 6 周后临床保持稳定的 8310 名 Medicare 患者中，CR 转诊率为 25.8%，转诊患者中 CR 的利用率为 4.1%（平均就诊次数：6.7）。未转诊的患者更有可能年龄较大、属于黑人种族，并且合并症负担较高。在调整分析中，符合条件的射血分数降低的心力衰竭患者被转诊至 CR（与未转诊相比）的 1 年死亡风险较低（风险比，0.84 [95% CI，0.70–1.00]；P=0.049），1 年再入院率无显着差异。 结论 从 2010 年至 2020 年，SCR 转诊率有所增加。然而，只有四分之一的患者被转诊至 CR CR。在接受 CR 转诊的符合条件的患者中，参与率较低，20 名患者中只有不到 1 名参与 CR。
BACKGROUNDCoverage for cardiac rehabilitation (CR) for patients with heart failure with reduced ejection fraction was expanded in 2014, but contemporary referral and participation rates remain unknown.METHODSPatients hospitalized for heart failure with reduced ejection fraction (≤35%) in the American Heart Association Get With The Guidelines–Heart Failure registry from 2010 to 2020 were included, and CR referral status was described as yes, no, or not captured. Temporal trends in CR referral were assessed in the overall cohort. Patient and hospital-level predictors of CR referral were assessed using multivariable-adjusted logistic regression models. Additionally, CR referral and proportional utilization of CR within 1-year of referral were evaluated among patients aged >65 years with available Medicare administrative claims data who were clinically stable for 6-weeks postdischarge. Finally, the association of CR referral with the risk of 1-year death and readmission was evaluated using multivariable-adjusted Cox models.RESULTSOf 69,441 patients with heart failure with reduced ejection fraction who were eligible for CR (median age 67 years; 33% women; 30% Black), 17,076 (24.6%) were referred to CR, and referral rates increased from 8.1% in 2010 to 24.1% in 2020 (Ptrend<0.001). Of 8310 patients with Medicare who remained clinically stable 6-weeks after discharge, the CR referral rate was 25.8%, and utilization of CR among referred patients was 4.1% (mean sessions attended: 6.7). Patients not referred were more likely to be older, of Black race, and with a higher burden of comorbidities. In adjusted analysis, eligible patients with heart failure with reduced ejection fraction who were referred to CR (versus not referred) had a lower risk of 1-year death (hazard ratio, 0.84 [95% CI, 0.70–1.00];P=0.049) without significant differences in 1-year readmission.CONCLUSIONSCR referral rates have increased from 2010 to 2020. However, only 1 in 4 patients are referred to CR. Among eligible patients who received CR referral, participation was low, with <1 of 20 participating in CR.