Wright S P, Verouhis D, Gamble G, Swedberg K, Sharpe N, Doughty R N
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Eur J Heart Fail. 2003 Mar;5(2):201-9. doi: 10.1016/s1388-9842(02)00201-5.
Heart failure (HF) is characterised by frequent hospital admissions and prolonged length of hospital stay. Admissions for HF have increased over the last decade while length of stay has decreased; the reasons for this change in length of stay are uncertain. This study investigates the effect of patient-related variables, in-hospital progress and complications on length of stay.
Patients admitted to Auckland Hospital general medical service and randomised into the Auckland Heart Failure Management Programme were included in this study.
One hundred and ninety-seven patients were included in this study. Mean age 73 years, mean left ventricular ejection fraction 32%; 52% had one or more previous HF admissions and 75% were New York Heart Association class IV at admission. Median length of hospital stay was 6 days (IQR 4, 9) which is comparable to the national average from New Zealand admission databases. Longer than average length of stay, defined as >6 days, was associated with the presence of peripheral congestion, duration of treatment with intravenous diuretic, the development of renal impairment, other acute medical problems at admission, iatrogenic complications during hospital stay, and social problems requiring intervention. Factors independently associated with length of stay in the top quartile (>10 days) on logistic regression included the presence of oedema at admission (OR 10.5), change in weight during stay (OR 1.3), duration of treatment with iv diuretic (OR 7.5), the development of renal impairment (OR 9.8), concurrent respiratory problems requiring specific treatment (OR 3.8), and social problems requiring intervention (OR 6.8).
Peripheral congestion, concomitant acute medical problems requiring specific treatment, the development of renal impairment and the presence of social problems were related to a longer than average length of hospital stay. Multivariate models only partly explained variance in hospital stay, suggesting the importance of pre-admission and post-discharge factors, including the healthcare environment, the availability of primary and secondary care resources, and the threshold for hospital admission.
心力衰竭（HF）的特点是频繁住院和住院时间延长。在过去十年中，因心力衰竭入院的人数有所增加，而住院时间却有所缩短；住院时间发生这种变化的原因尚不确定。本研究调查了与患者相关的变量、住院期间的病情进展和并发症对住院时间的影响。
纳入奥克兰医院普通内科服务部门收治并随机进入奥克兰心力衰竭管理项目的患者。
本研究纳入了197名患者。平均年龄73岁，平均左心室射血分数32%；52%的患者曾因心力衰竭入院一次或多次，75%的患者入院时为纽约心脏协会IV级。中位住院时间为6天（四分位间距4, 9），与新西兰入院数据库的全国平均水平相当。住院时间超过平均水平（定义为>6天）与外周充血、静脉利尿剂治疗持续时间、肾功能损害的发生、入院时的其他急性医疗问题、住院期间的医源性并发症以及需要干预的社会问题有关。逻辑回归分析显示，与住院时间处于最高四分位数（>10天）独立相关的因素包括入院时存在水肿（比值比10.5）、住院期间体重变化（比值比1.3）、静脉利尿剂治疗持续时间（比值比7.5）、肾功能损害的发生（比值比9.8）、需要特定治疗的并发呼吸问题（比值比3.8）以及需要干预的社会问题（比值比6.8）。
外周充血、需要特定治疗的并发急性医疗问题、肾功能损害的发生以及社会问题的存在与住院时间超过平均水平有关。多变量模型仅部分解释了住院时间的差异，这表明入院前和出院后因素的重要性，包括医疗保健环境、初级和二级护理资源的可用性以及住院门槛。
