The prognostic impact of specialist cardiology input in patients admitted for heart failure and normal ejection fraction.
The prognostic impact of specialist cardiology input in patients admitted for heart failure and normal ejection fraction.
复制标题
作者：
心脏专科护理与因失代偿性心力衰竭（HF）而入院的射血分数降低（HFrEF）心力衰竭（HF）患者的预后获益相关。然而，高达三分之一的HF和射血分数正常（HFnEF）患者没有接受专科心脏病学输入。这是否具有预后意义尚不清楚。分析了来自两个三级中心的HFnEF住院患者的数据。主要结局指标为随访期间的全因死亡率。次要结局为院内死亡率。共有1413例患者入选本研究。其中，23%（n = 322）未接受院内心脏病学专家的意见。与未接受专科治疗的患者相比，接受心脏病专家治疗的患者患高血压（73% vs. 79%，P = 0.03）和呼吸系统合并症（25% vs. 31%，P = 0.02）的可能性更低。同样，接受专科治疗的患者的临床表现更严重（纽约心脏协会III/IV级分别为83%和75%，P = 0.003;中度至重度外周水肿65%和54%，P < 0.001）。医疗管理相似，除了利尿剂的使用率更高（90% vs. 86%，P = 0.04）和接受专家输入的患者住院时间更长（9 vs. 4天，P < 0.001）。接受专家输入的患者和未接受专家输入的患者的长期结局相当。然而，专家输入与较低的院内死亡率独立相关（风险比0.19，置信区间0.09-0.43，P < 0.001）。在HFnEF患者中，院内心脏病学专家输入没有长期预后优势，但与院内死亡率降低独立相关。
Specialist cardiology care is associated with a prognostic benefit in patients with heart failure (HF) with reduced ejection fraction (HFrEF) admitted with decompensated HF. However, up to one third of patients admitted with HF and normal ejection fraction (HFnEF) do not receive specialist cardiology input. Whether this has prognostic implications is unknown. Data on patients hospitalized with HFnEF from two tertiary centres were analysed. The primary outcome measure was all‐cause mortality during follow‐up. The secondary outcome was in‐hospital mortality. A total of 1413 patients were included in the study. Of these, 23% (n = 322) did not receive in‐hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs. 79%, P = 0.03) and respiratory co‐morbidities (25% vs. 31%, P = 0.02) compared with those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (New York Heart Association III/IV 83% vs. 75% respectively, P = 0.003; moderate‐to‐severe peripheral oedema 65% vs. 54%, P < 0.001). Medical management was similar, except for a higher use of diuretics (90% vs. 86%, P = 0.04) and a longer length of stay for patients who received specialist input (9 vs. 4 days, P < 0.001). Long‐term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in‐hospital mortality (hazard ratio 0.19, confidence interval 0.09–0.43, P < 0.001). In‐hospital cardiology specialist input has no long‐term prognostic advantage in patients with HFnEF but is independently associated with reduced in‐hospital mortality.
登录
查看更多内容
影响因子：
3.8
作者：
Ta Anyu A;Badawy L;Cannata A;Bromage DI;Rind IA;Albarjas M;Piper S;Shah AM;McDonagh TA
通讯作者：
McDonagh TA
影响因子：
5.4
作者：
Samson R;Jaiswal A;Ennezat PV;Cassidy M;Le Jemtel TH
通讯作者：
Le Jemtel TH
影响因子：
13
作者：
Tsao, Connie W.;Lyass, Asya;Vasan, Ramachandran S.
通讯作者：
Vasan, Ramachandran S.
影响因子：
2.8
作者：
DOUGHERTY, AH;NACCARELLI, GV;GOLDSTEIN, RA
通讯作者：
GOLDSTEIN, RA
影响因子：
2.8
作者：
Emdin, Connor A.;Hsiao, Allan J.;Rahimi, Kazem
通讯作者：
Rahimi, Kazem