Efficacy of an Integrated Hospital-primary Care Program for Heart Failure: A Population-based Analysis of 56 742 Patients
Efficacy of an Integrated Hospital-primary Care Program for Heart Failure: A Population-based Analysis of 56 742 Patients
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DOI：
10.1016/j.rec.2013.12.005
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发表时间：
2014-04-01
影响因子：
5.9
通讯作者：
Bruguera, Jordi
中科院分区：
文献类型：
--
作者：
Comin-Colet, Josep;Maria Verdu-Rotellar, Jose;Bruguera, Jordi
导言和目的：心力衰竭方案的有效性已在临床试验中得到证实，但其在现实世界实践环境中的适用性更具争议。这项研究评估了在一个覆盖309 345人口的综合医疗区内管理心力衰竭患者的医院-初级保健一体化计划的可行性和有效性。方法：为了进行分析，我们纳入了西班牙加泰罗尼亚所有医院从2005年到2011年(该计划实施期间)连续入院的所有心力衰竭患者，并将接受该计划的患者的死亡率和再住院率与加泰罗尼亚医疗服务中心(Servei Catala De La Salut)所有剩余综合医疗区的患者的死亡率进行了比较。结果：我们纳入了56 742名患者。在研究期间，共有181 204人入院，30712人死亡。在调整后的分析中，与来自其他健康地区的54659名患者相比，接受该计划的2083名患者死亡风险较低(风险比=0.92[95%可信区间，0.86-0.97]；P=.005)，与临床相关的再入院风险较低(风险比=0.71[95%可信区间，0.66-0.76]；P<；.001)，心力衰竭再入院风险较低(风险比=0.86[95%可信区间，0.80-0.94]；P<；.001)。一旦该计划建立良好，对发病率和死亡率的积极影响就更加明显。结论：实施整合医院和社区的多学科心力衰竭管理计划是可行的，并与显著降低患者的发病率和死亡率有关。(C)2013年西班牙心脏学会。由Elsevier Espana，S.L.出版，版权所有。
Introduction and objectives: The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309 345.Methods: For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Catala de la Salut (Catalan Health Service).Results: We included 56 742 patients in the study. There were 181 204 hospital admissions and 30 712 deaths during the study period. In the adjusted analyses, when compared to the 54 659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio = 0.92 [95% confidence interval, 0.86-0.97]; P = .005), a lower risk of clinically-related readmission (hazard ratio = 0.71 [95% confidence interval, 0.66-0.76]; P < .001), and a lower risk of readmission for heart failure (hazard ratio = 0.86 [95% confidence interval, 0.80-0.94]; P < .001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established.Conclusions: The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality. (C) 2013 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S. L. All rights reserved.