Hospitalizations after heart failure diagnosis a community perspective.
Hospitalizations after heart failure diagnosis a community perspective.
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DOI：
10.1016/j.jacc.2009.08.019
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发表时间：
2009-10-27
影响因子：
24
通讯作者：
Roger, Veronique L.
中科院分区：
文献类型：
--
作者：
Dunlay, Shannon M.;Redfield, Margaret M.;Weston, Susan A.;Therneau, Terry M.;Long, Kirsten Hall;Shah, Nilay D.;Roger, Veronique L.
目的：确定社区心力衰竭(HF)确诊后住院治疗的终生负担和危险因素。心力衰竭患者的住院是一个主要的公共卫生问题，然而，心力衰竭诊断后住院的累积负担尚不清楚，也没有确定一致的住院危险因素。我们对明尼苏达州奥姆斯特县1987-2006年发生的所有心力衰竭病例进行了随机抽样验证，并评估了2007年心力衰竭确诊后的所有住院治疗情况。使用国际疾病分类第9次修订代码来确定住院的主要原因。为了解释反复发生的事件，Andersen-Gill模型被用来确定心力衰竭诊断后住院的预测因素。患者在死亡或最后一次随访时被审查。在1077例心衰患者中(平均年龄76.8岁，582例(54.0%)女性)，4359例患者在平均4.7年的随访期内住院。确诊后住院治疗较常见，至少住院1次者895例(83.1%)，≥-2、≥-3和≥分别住院4次(66.9%)、577例(53.6%)和459例(42.6%)。住院原因为心力衰竭713例(16.5%)，其他心血管原因936例(21.6%)，非心血管原因超过半数(n=2679，61.9%)。男性、糖尿病、慢性阻塞性肺疾病、贫血和内生肌酐清除量30毫升/分钟是住院的独立预测因素(p<；0.05)。在确诊为心力衰竭后，多次住院是很常见的，尽管不到一半是由于心血管原因。合并症与住院密切相关，这些信息可以用来确定有效的干预措施，以防止心力衰竭患者住院。
To determine the lifetime burden and risk factors for hospitalization after heart failure (HF) diagnosis in the community. Hospitalizations in patients with HF represent a major public health problem, however the cumulative burden of hospitalizations after HF diagnosis is unknown, and no consistent risk factors for hospitalization have been identified. We validated a random sample of all incident HF cases in Olmsted County, Minnesota from 1987–2006 and evaluated all hospitalizations after HF diagnosis through 2007. International Classification of Diseases, 9th Revision codes were used to determine the primary reason for hospitalization. To account for repeated events, Andersen-Gill models were used to determine the predictors of hospitalization after HF diagnosis. Patients were censored at death or last follow-up. Among 1077 HF patients (mean age 76.8 years, 582 [54.0%] female), 4359 hospitalizations occurred over a mean follow-up of 4.7 years. Hospitalizations were common after HF diagnosis, with 895 (83.1%) patients hospitalized at least once, and 721 (66.9%), 577 (53.6%) and 459 (42.6%) hospitalized ≥2, ≥3, and ≥4 times, respectively. The reason for hospitalization was HF in 713 (16.5%) hospitalizations, other cardiovascular in 936 (21.6%), while over half (n=2679, 61.9%) were non-cardiovascular. Male sex, diabetes mellitus, chronic obstructive pulmonary disease, anemia, and creatinine clearance <30 mL/min were independent predictors of hospitalization (p<0.05 for each). Multiple hospitalizations are common after HF diagnosis, though less than half are due to cardiovascular causes. Comorbid conditions are strongly associated with hospitalizations, information that could be used to define effective interventions to prevent hospitalizations in HF patients.
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