Lee Douglas S, Johansen Helen, Gong Yanyan, Hall Ruth E, Tu Jack V, Cox Jafna L
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Can J Cardiol. 2004 May 1;20(6):599-607.
Heart failure is a condition associated with significant mortality and morbidity. However, demographic features and outcomes following hospitalization for heart failure, and associated regional comparisons have not been performed in Canada.
Anonymously rendered records of patients hospitalized for incident heart failure in Canada were selected from the Canadian Institute for Health Information discharge abstract and hospital morbidity databases from fiscal years 1997/1998 to 1999/2000. The demographics, in-hospital mortality rate and heart failure readmission rates were compared among provinces and health regions.
A total of 83,406 patients were hospitalized for heart failure across Canada during the study period. The number of cases increased dramatically with each decade after age 50 years, with 85% of hospitalized patients being age 65 years and over. On average, in-hospital mortality per index admission in Canada was 9.5 deaths per 100 hospitalized cases. While the greatest burden of readmissions was among those 65 years of age and over, heart failure readmission rates were similar across age groups. Among all patients surviving the index admission, heart failure readmission rates were 8.7%, 14.1% and 23.6% at 30 days, 90 days and one year, respectively. The highest age- and sex-adjusted in-hospital mortality rates were 11.9% (95% CI 10.6 to 13.2) in Newfoundland/Labrador and 11.6% (95% CI 10.6 to 12.7) in Nova Scotia. The highest readmission rates at one year were 26.9% (95% CI 24.9 to 28.9) in Newfoundland/Labrador, 26.3% (95% CI 25.0 to 27.7) in Saskatchewan and 25.2% (95% CI 24.3 to 26.1) in British Columbia. There were significant regional variations in heart failure readmission rates and mortality.
There is a great burden of heart failure in Canada, increasing significantly with age. The mortality and readmission rates for this condition are high and exhibit variation among health regions and provinces. Factors contributing to regional variations in these outcomes merit further study.
心力衰竭是一种与高死亡率和高发病率相关的疾病。然而，加拿大尚未对心力衰竭住院患者的人口统计学特征、预后以及相关的地区差异进行研究。
从加拿大卫生信息研究所1997/1998财年至1999/2000财年的出院摘要和医院发病率数据库中，选取因首次发生心力衰竭而住院的加拿大患者的匿名记录。对各省和卫生区域的人口统计学、住院死亡率和心力衰竭再入院率进行比较。
在研究期间，加拿大共有83406名患者因心力衰竭住院。50岁以后，每十年病例数急剧增加，85%的住院患者年龄在65岁及以上。加拿大平均每次首次入院的住院死亡率为每100例住院病例中有9.5例死亡。虽然再入院负担最大的是65岁及以上的人群，但各年龄组的心力衰竭再入院率相似。在首次入院存活的所有患者中，30天、90天和1年时的心力衰竭再入院率分别为8.7%、14.1%和23.6%。年龄和性别调整后的最高住院死亡率在纽芬兰和拉布拉多为11.9%（95%可信区间10.6至13.2），在新斯科舍为11.6%（95%可信区间10.6至12.7）。1年时最高的再入院率在纽芬兰和拉布拉多为26.9%（95%可信区间24.9至28.9），在萨斯喀彻温省为26.3%（95%可信区间25.0至27.7），在不列颠哥伦比亚省为25.2%（95%可信区间24.3至26.1）。心力衰竭再入院率和死亡率存在显著地区差异。
加拿大心力衰竭负担沉重，且随年龄显著增加。这种疾病的死亡率和再入院率很高，且在各卫生区域和省份存在差异。导致这些结果地区差异的因素值得进一步研究。
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