In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures
In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures
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DOI：
10.1093/eurheartj/ehy528
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发表时间：
2018-11-21
影响因子：
39.3
通讯作者：
Bollmann, Andreas
中科院分区：
文献类型：
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作者：
Koenig, Sebastian;Ueberham, Laura;Bollmann, Andreas
目的心房颤动（AFib）和心房扑动（AFlut）是常见的心律失常，随着有创手术的使用增加。建议对相关安全终点进行稳定的重新评估，质量管理和按绩效付费计划都在不断发展。因此，本研究的目的是(i)调查和报告总体住院死亡率和侵袭性心律失常相关手术的死亡率，（ii）在德国范围内的医院网络中确定死亡率预测因素。方法和结果采用国际疾病及相关健康问题统计分类-操作和程序代码对2010 - 2017年Helios 78家医院提供的管理数据进行分析，以确定AFib或AFlut患者为主要出院诊断或辅助诊断，并结合侵入性心律失常相关干预措施。16502例患者住院死亡率为0.6%，观察期内由0.75%降至0.5% （P < 0.01）。在多变量分析中，年龄[比值比（OR） 2.69, 95%可信区间（CI） 2.36-3.05；P < 0.01]、高中心容积（OR 0.57, 95% CI 0.50-0.65, P < 0.01）、急诊住院率（OR 1.57, 95% CI 1.38-1.79, P < 0.01）和Charlson共病指数（CCI, OR 4.95, 95% CI 4.50-5.44, P < 0.01）是院内死亡率的独立预测因子。左房导管消融（CA, n = 21744）的死亡率为0.05%，右房导管消融（n = 9972）的死亡率为0.3%，左房附件封堵器植入（n = 2309）的死亡率为0.56%。结论：我们首次在德国范围内的多中心管理数据集中分析了房性心律失常患者的住院死亡率。这允许在现实世界环境中对临床重要终点进行可行的、可比较的和最新的性能测量，这可能有助于质量管理计划和基于价值的医疗保健。
Aims Atrial fibrillation (AFib) and atrial flutter (AFlut) are common arrhythmias with increased use of invasive procedures. A steady re-evaluation of relevant safety endpoints is recommended and both quality management and payfor- performance programs are evolving. Therefore, the aims of this study were (i) to investigate and report overall in-hospital mortality and mortality of invasive arrhythmia-related procedures and (ii) to identify mortality predictors in a German-wide hospital network.Methods and results Administrative data provided by 78 Helios hospitals between 2010 and 2017 were examined using International Statistical Classification of Diseases and Related Health Problems-and Operations and Procedures-codes to identify patients with AFib or AFlut as main discharge diagnosis or secondary diagnosis combined with invasive arrhythmia-related interventions. In 161 502 patients, in-hospital mortality was 0.6% with a significant decrease from 0.75% to 0.5% (P < 0.01) during the observational period. In multivariable analysis, age [ odds ratio (OR) 2.69, 95% confidence interval (CI) 2.36-3.05; P < 0.01], high centre volume (OR 0.57, 95% CI 0.50-0.65; P < 0.01), emergency hospital admission (OR 1.57, 95% CI 1.38-1.79; P < 0.01), and Charlson Comorbidity Index (CCI, OR 4.95, 95% CI 4.50-5.44; P < 0.01) were found as independent predictors of in-hospital mortality. Mortality rates were 0.05% for left atrial catheter ablation (CA, n = 21 744), 0.3% for right atrial CA (n = 9972), and 0.56% for implantation of a left atrial appendage occluder (n = 2309), respectively.Conclusion We analysed for the first time in-hospital mortality rates of patients with atrial arrhythmias in a German-wide, multi-centre administrative dataset. This allows feasible, comparable, and up-to-date performance measurement of clinically important endpoints in a real-world setting which may contribute to quality management programs and towards value-based healthcare.