Patients With Heart Failure Readmitted to the Original Hospital Have Better Outcomes Than Those Readmitted Elsewhere.
Patients With Heart Failure Readmitted to the Original Hospital Have Better Outcomes Than Those Readmitted Elsewhere.
复制标题
回教到原始医院的心力衰竭的患者的结局比其他地方的患者更好。
DOI：
10.1161/jaha.116.004892
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发表时间：
2017-05-10
影响因子：
5.4
通讯作者：
Kaul P
中科院分区：
文献类型：
--
作者：
McAlister FA;Youngson E;Kaul P
在心力衰竭住院后，高达五分之一的再次住院发生在不同的医院。这对信息的连续性产生了负面影响，但重新入院的地点是否会影响随后的结果尚不清楚。对加拿大2004年4月至2013年12月期间所有初步诊断为心力衰竭的出院患者进行了回顾性队列研究。我们比较了30天内再次入院的患者与原始医院和不同医院的患者。在217039名心力衰竭患者中(平均年龄76.8岁，男性50.1%)，39名368名(18.1%)在30天内再次入院-32名771名(83.2%)再次入院，6597名(16.8%)被送往不同的医院(随着时间的推移，从2004年的15.6%上升到2013年的18.5%；趋势P=0.001)。再次入院的患者更年轻，更有可能是男性，居住在农村，出院时间较近，在教学医院住院的指标，以及再次入院时由救护车送来的。与不同医院的再入院相比，原医院的再入院时间显著缩短(平均10.4天[95%可信区间，10.3-10.6]比11.6天[95%可信区间，11.3-12.0]；调整后的平均值，11.0比12.0；P<；0.0001)，并且死亡率更低(14.4%比15.0%；调整后的优势比，0.89；95%可信区间，0.82-0.96)。随着时间的推移，再次住院到不同的医院变得越来越频繁，与重新入院相比，住院时间更长，死亡率更高。我们的发现提供了进一步的证据，证明护理碎片化可能对心力衰竭患者有害。
Up to one fifth of readmissions after a heart failure hospitalization occur at a different hospital. This negatively impacts information continuity, but whether site of readmission impacts subsequent outcomes is unclear. Retrospective cohort study of all patients discharged with a primary diagnosis of heart failure in Canada between April 2004 and December 2013. We compared patients readmitted within 30 days to the original hospital versus a different hospital. Of the 217 039 heart failure patients (mean age, 76.8 years, 50.1% male), 39 368 (18.1%) were readmitted within 30 days—32 771 (83.2%) to the original hospital and 6597 (16.8%) to a different hospital (increasing over time from 15.6% in 2004 to 18.5% by 2013; P for trend=0.001). Patients readmitted to different hospitals were younger and were more likely to be male, have a rural residence, a more‐recent discharge year, an index hospitalization at a teaching hospital, and to be brought in by ambulance at the time of the readmission. Readmissions to the original hospital were substantially shorter (mean, 10.4 days [95% CI, 10.3–10.6] versus 11.6 days [95% CI, 11.3–12.0]; adjusted means, 11.0 versus 12.0; P<0.0001) and had lower mortality (14.4% versus 15.0%; adjusted odds ratio, 0.89; 95% CI, 0.82–0.96) than readmissions to different hospitals. Readmissions to a different hospital are becoming more frequent over time and are associated with longer stays and higher mortality rates than readmissions to the original hospital. Our findings provide further evidence that care fragmentation may be deleterious for patients with heart failure.