Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions
Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions
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DOI：
10.1161/circheartfailure.117.004634
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发表时间：
2018-04-01
影响因子：
9.7
通讯作者：
Kociol, Robb D.
中科院分区：
文献类型：
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作者：
Fleming, Lisa M.;Zhao, Xin;Kociol, Robb D.
背景：早期Amberment（EA）与改善机械通气和卒中患者的结局相关。对于急性心力衰竭住院患者是否存在相同的相关性尚不清楚。我们试图确定是否EA心力衰竭住院患者与住院时间，出院处置，30天后出院再入院，和mortality.METHODS AND RESERVATIONS：研究人群包括369家医院和285653例心力衰竭患者参加的指南，心力衰竭登记。我们在医院水平上使用多变量逻辑回归和广义估计方程来确定EA的预测因子，并确定EA和结局之间的相关性。65%的患者在入院的第2天可以走动。与最低25%的患者相比，EA的患者水平预测因素包括年龄较小、男性和东北部以外的住院（P4天）（比值比，0.83;置信区间，0.73-0.94; P=0.004）。在一个按服务收费的医疗保险受益人小组中，我们发现EA率最高的四分位数的医院显示出统计学显著性的30天再入院率低24%（P
BACKGROUND: Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality.METHODS AND RESULTS: The study population included 369 hospitals and 285653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (P4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P=0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (P