Meta-Analysis of Risks for Short-Term Readmission in Patients With Heart Failure
Meta-Analysis of Risks for Short-Term Readmission in Patients With Heart Failure
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DOI：
10.1016/j.amjcard.2015.11.048
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发表时间：
2016-02-15
影响因子：
2.8
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
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作者：
Saito, Makoto;Negishi, Kazuaki;Marwick, Thomas H.
本研究旨在量化心力衰竭（HF）患者短期再入院的风险因素。对电子数据库进行系统性检索，查找报告HF患者出院后590天内全因再入院或全因死亡的综合主要结局的相对风险、比值比和风险比的研究。提取临床特征、研究设计、结局类型和发生率、每个风险因素的单变量效应量及其相关的95%置信区间。将每个单变量效应量合并，并在单独的荟萃分析中使用由逆方差加权的随机效应模型进行计算。还评估了多变量模型中每个风险因素的显著性频率，以确认其独立性。纳入了69项研究（2，038，524例患者），报告了144个因素，其中32个报告了两次以上。合并主要结局的显著相关性为慢性肺病、慢性肾病、动脉粥样硬化性血管疾病（外周、冠状动脉和脑血管）、糖尿病、贫血、收缩压降低、既往住院史、多学科治疗和β受体阻滞剂和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的使用。在多变量分析中，这些变量中的大多数仍然与合并的主要结局独立相关。然而，年龄、男性、黑人、高血压、血脂异常、吸烟、房颤、癌症、利尿剂、醛固酮拮抗剂和地高辛的使用并不显著。总之，与标准风险相比，非心血管合并症、身体状况差、住院史和未使用循证药物与HF患者90天再入院或死亡的相关性更强。(C)2016 Elsevier Inc. All rights reserved.
This investigation sought to quantify the risk factors for short-term readmission in patients with heart failure (HF). Electronic databases were systematically searched for studies reporting relative risk, odds ratio, and hazard ratio for the combined primary outcome of all cause hospital readmission or all-cause mortality 590 days from discharge of patients with HF. Clinical characteristics, study design, type and incidence of outcome, univariable effect sizes for each risk factor, and their associated 95% confidence intervals were extracted. Each univariable effect size was pooled and computed in a separate meta-analysis using random effects models weighted by inverse variance. The frequency of significance of each risk factor in multivariable models was also assessed to confirm their independence. Sixty-nine studies (2,038,524 patients) were included and 144 factors were reported, including 32 reported more than twice. The significant associations of the combined primary outcome were chronic lung disease, chronic kidney disease, atherosclerotic vascular disease (peripheral, coronary, and cerebrovascular), diabetes, anemia, lower systolic blood pressure, previous admission, multidisciplinary treatment, and use of beta-blockade and angiotensin-converting enzyme inhibition or angiotensin receptor blockade. In multivariable analyses, most of these variables remained independently associated with the combined primary outcome. However, age, male gender, black race, hypertension, dyslipidemia, smoking, atrial fibrillation, cancer, and uses of diuretics, aldosterone antagonists, and digoxin were not significant. In conclusion, non cardiovascular co-morbidities, poor physical condition, history of admission, and failure to use evidence-based medication are more strongly associated with 90-day readmission or death than standard risks in patients with HF. (C) 2016 Elsevier Inc. All rights reserved.