Referral for Specialist Follow-up and Its Association With Post-discharge Mortality Among Patients With Systolic Heart Failure (from the National Heart Failure Audit for England and Wales)
Referral for Specialist Follow-up and Its Association With Post-discharge Mortality Among Patients With Systolic Heart Failure (from the National Heart Failure Audit for England and Wales)
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DOI：
10.1016/j.amjcard.2016.10.021
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发表时间：
2017-02-01
影响因子：
2.8
通讯作者：
Rahimi, Kazem
中科院分区：
文献类型：
--
作者：
Emdin, Connor A.;Hsiao, Allan J.;Rahimi, Kazem
对于因心力衰竭 (HF) 恶化而入院的患者，建议出院后尽早随访。由心脏病专家进行随访是否可以改善结果尚不确定。我们的目的是确定心脏病随访与出院心衰患者死亡风险之间的关系。使用国家心力衰竭审计（英格兰和威尔士）的数据，我们调查了 2007 年至 2013 年间从 185 家医院出院的 68,772 名心力衰竭且左心室射血分数降低的患者，转诊至心脏病学随访对 30 天和 1 年死亡率的影响。主要分析使用工具变量分析，并辅以层次逻辑和倾向匹配模型。在医院层面，转诊至心脏病专家的比例从 6% 到 96% 不等。转诊至心脏病专家的中位比值比 (OR) 为 2.3（95% 置信区间 [CI] 2.1 至 2.5），这表明，平均而言，随机选择的一家医院与另一家医院之间，患者出院后转诊至心脏病专家随访的几率相差 2.3 倍。根据转诊进行心脏病学随访的患者比例（每个地区），与没有心脏病学随访计划（即由家庭医生进行标准随访）相比，转诊进行心脏病学随访与较低的 30 天死亡率（OR 0.70；95% CI 0.55 至 0.89）和 1 年死亡率（OR 0.81；95% CI 0.68 至 0.95）相关。分层逻辑模型和倾向匹配模型的结果是一致的（分层模型和倾向匹配模型的 30 天死亡率 OR 0.66；95% CI 分别为 0.61 至 0.72 和 0.66；95% CI 0.58 至 0.76）。对于入院且症状恶化的心力衰竭且左心室射血分数降低的患者，出院后转诊至心脏病学服务机构进行随访与早期和晚期死亡率的降低密切相关。 (C) 2016 年作者。由爱思唯尔公司出版
For patients admitted with worsening heart failure (HF), early follow-up after discharge is recommended. Whether outcomes can be improved when follow-up is done by cardiologists is uncertain. We aimed to determine the association between cardiology follow-up and risk of death for patients with HF discharged from hospital. Using data from the National Heart Failure Audit (England and Wales), we investigated the effect of referral to cardiology follow-up on 30-day and 1-year mortality in 68,772 patients with HF and a reduced left ventricular ejection fraction discharged from 185 hospitals from 2007 to 2013. The primary analyses used instrumental variable analysis complemented by hierarchical logistic and propensity-matched models. At the hospital level, rates of referral to cardiologists varied from 6% to 96%. The median odds ratio (OR) for referral to cardiologist was 2.3 (95% confidence interval [CI] 2.1 to 2.5), suggesting that, on average, the odds of a patient being referred for cardiologist follow-up after discharge differed 2.3 times from one randomly selected hospital to another one. Based on the proportion of patients (per region) referred for cardiology follow-up, referral for cardiology follow-up was associated with lower 30-day (OR 0.70; 95% CI 0.55 to 0.89) and 1-year mortality (OR 0.81; 95% CI 0.68 to 0.95) compared with no plans for cardiology follow-up (i.e., standard follow-up done by family doctors). Results from hierarchical logistic models and propensity-matched models were consistent (30-day mortality OR 0.66; 95% CI 0.61 to 0.72 and 0.66; 95% CI 0.58 to 0.76 for hierarchical and propensity matched models, respectively). For patients with HF and a reduced left ventricular ejection fraction admitted to hospital with worsening symptoms, referral to cardiology services for follow-up after discharge is strongly associated with reduced mortality, both early and late. (C) 2016 The Authors. Published by Elsevier Inc.