Preventable causative factors leading to hospital admission with decompensated heart failure
Preventable causative factors leading to hospital admission with decompensated heart failure
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DOI：
10.1136/hrt.80.5.437
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发表时间：
1998-11-01
期刊：
影响因子：
5.7
通讯作者：
Thimme, W
中科院分区：
文献类型：
--
作者：
Michalsen, A;König, G;Thimme, W
目的 - 确定导致心脏失代偿以及随后因心力衰竭入院的各种因素（尤其是可预防因素）的分布情况及其重要性。
方法 - 在一年期间，前瞻性招募患者，并在其住院期间由经过培训的医务人员通过结构化的个人访谈以及临床检查和实验室检查进行评估。
地点 - 德国柏林一家教学附属综合社区医院的心内科。
患者 - 连续抽取179例因原有心力衰竭急性失代偿入院的患者。
主要结局指标 - 导致心力衰竭入院的致病因素的比例分布；可预防因素的相对重要性；患者对饮食和药物治疗的依从性细节以及对药物的了解情况。
结果 - 平均（标准差）年龄为75.4（9.9）岁。在85.5%的患者中确定了失代偿性心力衰竭的潜在致病因素。不遵守医疗方案是最常见的确定因素，在41.9%的病例中被视为心脏失代偿的原因。23.5%的患者存在不遵医嘱服药的情况。与入院相关的其他因素包括冠状动脉缺血（13.4%）、心律失常（6.1%）、未控制的高血压（5.6%）以及入院前治疗不充分（12.3%）。总体而言，54.2%的入院情况可被视为是可预防的。
结论 - 柏林一家地区医院中许多慢性心力衰竭失代偿患者的入院是可预防的。有必要采取措施改善这种情况，并且需要对包括患者教育、患者随访和医生培训在内的项目进行评估。
Objective-To determine the distribution and importance of various factors, especially the preventable ones, that contribute to cardiac decompensation and subsequent hospital admission for heart failure.Methods-During a one year period patients were prospectively recruited and evaluated during their hospital stay by means of a structured personal interview by trained medical staff and through clinical examination and laboratory investigation.Setting-The cardiological department at a teaching affiliated general community hospital in Berlin, Germany.Patients-Consecutive sample of 179 patients admitted to hospital with acute decompensation of pre-existing heart failure.Main outcome measures-Proportional distribution of causative factors leading to hospital admission for heart failure; relative importance of preventable factors; details of patient compliance with diet and medication, and knowledge about medication.Results-Mean (SD) age was 75.4 (9.9) years. Potential causative factors for decompensated heart failure were identified in 85.5% of patients. Lack of adherence to the medical regimen was the most commonly identified factor and was regarded as the cause of the cardiac decompensation in 41.9% of cases. Non-compliance with drugs was found in 23.5% of patients. Other factors related to hospital admission were coronary ischaemia (13.4%), cardiac arrhythmias (6.1%), uncontrolled hypertension (5.6%), and inadequate preadmission treatment (12.3%). In all, 54.2% of admissions could be regarded as preventable.Conclusions-Many hospital admissions for decompensation of chronic heart failure in patients at a district hospital in Berlin are preventable. Measures are necessary to improve this situation and evaluation of programmes that include patient education, patient follow up, and physician training is needed.