Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-Day Readmission.
Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-Day Readmission.
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DOI：
10.1016/j.cardfail.2021.01.020
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发表时间：
2021-05
影响因子：
6
通讯作者：
Ziaeian B
中科院分区：
文献类型：
--
作者：
Feng Z;Fonarow GC;Ziaeian B
心源性休克(CS)入院的患者死亡率、再住院率和医疗费用都很高。姑息治疗服务(PCS)可能未得到充分利用，与30天再入院和其他预测因素之间的关联尚不清楚。我们研究了美国有无PCS的CS入院患者30天再入院的频率、病因和预测因素。使用2017年全国再招生数据库，我们确定了(1)CS、(2)有PCS的CS和(3)没有PCS的CS的招生情况。我们使用多变量Logistic回归分析比较了再入院结果和预测因素的差异，并考虑了调查设计。在2017年全国133,738例CS住院患者中，36.3%的患者在住院期间死亡。在存活的患者中，8.6%的人使用了PCS，21%的人在30天内再次入院。有无PCS的CS组之间的差异包括死亡率(72.8%比27%)、再住院率(11.6%比21.9%)、最常出院的目的地(50.2%的熟练护理机构比36.4%的家庭)、每个患者的住院费用(51,083美元±2,629美元比66,815±1,729美元)。两组的初次再入院诊断均为心力衰竭(32.1%对24.4%)。使用个人电脑与较低的再住院率相关(优势比，0.462；95%可信区间，0.408-0.524；P<；.001)。不复苏状态、私人支付、自我支付和心脏骤停是负向预测因素，而多重并存是再次入院的正向预测因素。2017年，在CS招生中使用PCS的比例仍然较低，为8.6%。个人电脑的使用与较低的30天再住院率和住院费用有关。PC与危重心脏病患者未来急性护理服务使用量的减少有关，但对高危心脏病患者的使用率不足。
Patients admitted with cardiogenic shock (CS) have high mortality rates, readmission rates, and healthcare costs. Palliative care services (PCS) may be underused, and the association with 30-day readmission and other predictive factors is unknown. We studied the frequency, etiologies, and predictors of 30-day readmission in CS admissions with and without PCS in the United States. Using the 2017 Nationwide Readmissions Database, we identified admissions for (1) CS, (2) CS with PCS, and (3) CS without PCS. We compared differences in outcomes and predictors of readmission using multivariable logistic regression analysis accounting for survey design. Of 133,738 CS admissions nationally in 2017, 36.3% died inpatient. Among those who survived, 8.6% used PCS and 21% were readmitted within 30 days. Difference between CS with and without PCS groups included mortality (72.8% vs 27%), readmission rate (11.6% vs 21.9%), most frequent discharge destination (50.2% skilled nursing facilities vs 36.4% home), hospitalization cost per patient ($51,083 ± $2,629 vs $66,815 ± $1,729). The primary readmission diagnoses for both groups were heart failure (32.1% vs 24.4%). PCS use was associated with lower rates of readmission (odds ratio, 0.462; 95% confidence interval, 0.408–0.524; P < .001). Do-not-resuscitate status, private pay, self-pay, and cardiac arrest were negative predictors, and multiple comorbidities was a positive predictor of readmission. The use of PCS in CS admissions remains low at 8.6% in 2017. PCS use was associated with lower 30-day readmission rates and hospitalization costs. PCS are associated with a decrease in future acute care service use for critically ill cardiac patients but underused for high-risk cardiac patients.
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影响因子：
5.4
作者：
Kavalieratos D;Mitchell EM;Carey TS;Dev S;Biddle AK;Reeve BB;Abernethy AP;Weinberger M
通讯作者：
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作者：
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