Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people
Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people
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DOI：
10.1002/ejhf.709
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发表时间：
2017-09-01
影响因子：
18.2
通讯作者：
Hemingway, Harry
中科院分区：
文献类型：
--
作者：
Koudstaal, Stefan;Pujades-Rodriguez, Mar;Hemingway, Harry
目的：心力衰竭（HF）恶化住院患者的预后得到了很好的描述，但不是在非急性环境中，如初级保健或二级门诊护理单独管理的患者。我们评估了不同医疗水平的HF分布，并评估了在初级保健中记录的HF患者的预后差异，方法和结果本研究是CALIBER计划的一部分，该计划包括来自初级保健，住院，以及210万英格兰居民的死亡证明我们确定了89554例新记录的HF患者，其中23547例（26%）在PC中记录但从未住院，30629例（34%）住院但在PC中未知，23681例（27%）在两者中，11697例（13%）仅在死亡证明中。ACE抑制剂、β-受体阻滞剂和盐皮质激素受体拮抗剂的处方率最高的是已知在这两种情况下的患者。前三组的5年生存率分别为43.9% [95%可信区间（CI）43.2-44.6%]，21.7%[95%可信区间（CI）43.2-44.6%]，（95% CI 21.1-22.2%）和39.8%（95% CI 39.2-40.5%），而88.1%（95%CI 87.9-88.3%）。结论在一般人群中，四分之一的HF患者在中位随访1.7年内不会因HF恶化而住院，但他们的5年预后仍然很差。因HF恶化而入院但在初级保健中不知道HF的患者预后和管理最差。减轻HF的预后负担需要在患者的识别、特征分析和治疗方面在初级和二级护理之间具有更大的一致性。
Aims The prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non-acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contextsMethods and results This study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5-year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2-44.6%], 21.7% (95% CI 21.1-22.2%), and 39.8% (95% CI 39.2-40.5%), compared with 88.1% (95% CI 87.9-88.3%) in the age-and sex-matched general population.Conclusion In the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow-up of 1.7 years, yet they still have a poor 5-year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients.