Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure
Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure
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DOI：
10.1016/s0735-1097(03)00947-1
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发表时间：
2003-10-01
影响因子：
24
通讯作者：
Wu, AW
中科院分区：
文献类型：
--
作者：
Braunstein, JB;Anderson, GF;Wu, AW
目的研究非心脏合并症对老年慢性心力衰竭(CHF)患者潜在可预防的住院率和死亡率的影响。然而，关于非心脏合并症如何使这些患者的护理复杂化，人们知之甚少。方法这是一项横断面研究，研究对象为年龄大于或等于65岁的122630名CHF患者，通过随机抽取5%的美国联邦医疗保险受益人进行研究。我们评估了20种最常见的非心脏合并症与一年的潜在可预防住院率和总死亡率的关系。结果65%的样本至少有一次住院治疗，其中50%是潜在的可预防的。慢性心力衰竭的恶化占潜在可预防住院的55%。近40%的CHF患者有大于或等于5次非心脏并发症，这一组患者占所有CHF患者住院总天数的81%。住院和潜在可预防住院的风险随着慢性病的数量而显著增加(P<；0.0001)。在控制了人口统计学因素和其他诊断后，与CHF可预防和全原因可预防住院的风险显著增加相关的合并症和死亡率，包括慢性阻塞性肺疾病/支气管扩张、肾功能衰竭、糖尿病、抑郁症和其他下呼吸道疾病(均为P<；0.01)。结论非心脏合并症在老年CHF患者中非常普遍，并与不良临床结果密切相关。心脏病专家和其他常规护理老年CHF患者的提供者可能会通过更好地认识可能使传统CHF管理策略复杂化的非CHF情况，来改善这一高危人群的预后。(C)2003年，由美国心脏病学会基金会提供。
OBJECTIVES We studied the impact of noncardiac comorbidity on potentially preventable hospitalizations and mortality in elderly patients with chronic heart failure (CHF).BACKGROUND Chronic HF disproportionately affects older individuals, who typically have extensive comorbidity. However, little is known about how noncardiac comorbidity complicates care in these patients.METHODS This was a cross-sectional study of 122,630 individuals age greater than or equal to65 years with CHF identified through a 5% random sample of all U.S. Medicare beneficiaries. We assessed the relationship of the 20 most common noncardiac comorbidities to one-year potentially preventable hospitalizations and total mortality. Preventable hospitalizations were determined by admissions for ambulatory care sensitive conditions using predefined criteria.RESULTS Sixty-five percent of the sample had at least one hospitalization, of which 50% were potentially preventable. Exacerbations of CHF accounted for 55% of potentially preventable hospitalizations. Nearly 40% of patients with CHF had greater than or equal to5 noncardiac comorbidities, and this group accounted for 81% of the total inpatient hospital days experienced by all CHF patients. The risk of hospitalization and potentially preventable hospitalization strongly increased with the number of chronic conditions (both p < 0.0001). After controlling for demographic factors and other diagnoses, comorbidities that were associated consistently with notably higher risks for CHF-preventable and all-cause preventable hospitalizations, and mortality, included chronic obstructive pulmonary disease/bronchiectasis, renal failure, diabetes, depression, and other lower respiratory diseases (all p < 0.01).CONCLUSIONS Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies. (C) 2003 by the American College of Cardiology Foundation.