Di Lenarda Andrea, Scherillo Marino, Maggioni Aldo Pietro, Acquarone Nicola, Ambrosio Giovanni Battista, Annicchiarico Massimo, Bellis Paolo, Bellotti Paolo, De Maria Renata, Lavecchia Rinaldo, Lucci Donata, Mathieu Giovanni, Opasich Cristina, Porcu Maurizio, Tavazzi Luigi, Cafiero Massimo
Maggiore Hospital, Department of Cardiology, Trieste, Italy.
Am Heart J. 2003 Oct;146(4):E12. doi: 10.1016/S0002-8703(03)00315-6.
The purpose pf the current article is to describe the clinical profile, use of resources, management and outcome in a population of real-world inpatients with heart failure.
With a prospective, cross-sectional survey on acute hospital admissions, we evaluated the overall and provider-related differences in patient characteristics, diagnostic work-up, treatment and inhospital outcome of 2127 patients with heart failure admitted to 167 cardiology departments and 250 internal medicine departments between February 14 and 25, 2000. Patients admitted to cardiology units were younger (56.3% >70 years vs 76.2%, P <.0001), had more severe symptoms (NYHA IV 35% vs 29%, P =.00014), and more often underwent evaluation of ventricular function (89.3% vs 54.8%, P <.0001) and coronary angiography (7.5% vs 0.9%, P <.0001) than those admitted to medical units. Moreover, they were more often prescribed beta-blockers (17.8% vs 8.7%, P <.0001). However, prescription of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (78.7% vs 81.5%, P = not significant [NS]) and inhospital mortality (5.2% vs 5.9%, P = NS) were similar. A 6-month follow-up visit was performed in 56.4% of cases (68.2% of cardiology vs 49.4% of medicine patients, P <.0001); 6-month readmission (43.7% vs 45.4%, P = NS) and mortality (13.9% vs 16.7%, P = NS) rates were similar.
Patients with heart failure admitted to cardiology and internal medicine units represent 2 clearly different populations. In both groups, diagnostic procedures and evidence-based treatments, such as beta-blockers, appeared to be underused, and there was a lack of structured follow-up, as well as a poor 6-month prognosis.
本文的目的是描述现实世界中心力衰竭住院患者的临床特征、资源利用情况、管理及预后。
通过对急性住院患者进行前瞻性横断面调查，我们评估了2000年2月14日至25日期间入住167个心内科和250个内科的2127例心力衰竭患者在患者特征、诊断检查、治疗及住院结局方面的总体差异和与医疗服务提供者相关的差异。入住心内科的患者更年轻（70岁以上患者占56.3% 对比76.2%，P<.0001），症状更严重（纽约心脏病协会IV级患者占35% 对比29%，P=.00014），与入住内科的患者相比，更常接受心室功能评估（89.3% 对比54.8%，P<.0001）和冠状动脉造影（7.5% 对比0.9%，P<.0001）。此外，他们更常被处方β受体阻滞剂（17.8% 对比8.7%，P<.0001）。然而，血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的处方率（78.7% 对比81.5%，P=无显著差异[NS]）及住院死亡率（5.2% 对比5.9%，P=NS）相似。56.4%的病例进行了6个月的随访（心内科患者为68.2%，内科患者为49.4%，P<.0001）；6个月再入院率（43.7% 对比45.4%，P=NS）和死亡率（13.9% 对比16.7%，P=NS）相似。
入住心内科和内科的心力衰竭患者代表两个明显不同的群体。在这两组中，诊断程序和基于证据的治疗方法，如β受体阻滞剂，似乎未得到充分利用，缺乏结构化随访，且6个月预后较差。
