Rodríguez-Artalejo Fernando, Guallar-Castillón Pilar, Herrera Manuel Conde, Otero Carmen Montoto, Chiva Maite Olcoz, Ochoa Concepción Carreño, Banegas José R, Pascual Carlos Rodríguez
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
J Card Fail. 2006 Oct;12(8):621-7. doi: 10.1016/j.cardfail.2006.06.471.
This study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure.
Prospective study conducted with 371 patients, age 65 and older, admitted for heart failure-related emergencies at 4 Spanish hospitals. Social network was measured at baseline with a 4-item questionnaire that ascertained whether subjects were married, lived with another person(s), saw or had telephone contact with family members daily or almost daily, and were at home alone for less than 2 hours per day. Social network was deemed "high" where all 4 items were present, "moderate" where 3 were present, and "low" where 2 or fewer were present. Analyses were performed using Cox models, and adjusted for the main confounders. A total of 55% of patients had high or moderate social networks. During a median follow-up of 6.5 months, 135 (36.4%) patients underwent a first emergency rehospitalization and 68 (18.3%) died. Compared with patients with high social network, hospital readmission was more frequent among those who had moderate (hazard ratio [HR] 1.87; 95% confidence interval [CI] 1.06-3.29; P < .05) and low social networks (HR 1.98; 95% CI 1.07-3.68; P < .05). This relationship showed a positive dose-response (p for linear trend 0.042). The magnitude of this association was comparable to that of other important predictors of readmission, such as previous hospitalization. No relationship was observed between social network and death.
A very simple questionnaire measuring social network can identify patients with a higher short-term risk of hospital readmission.
本研究探讨老年心力衰竭患者的社交网络与再次入院及死亡率之间的关系。
对西班牙4家医院收治的371例65岁及以上因心力衰竭相关急症入院的患者进行前瞻性研究。在基线时用一份包含4个条目的问卷测量社交网络，该问卷用以确定受试者是否已婚、是否与他人同住、是否每天或几乎每天与家庭成员见面或有电话联系，以及每天独自在家的时间是否少于2小时。若4个条目均符合，则社交网络被视为“高”；若符合3个条目，则为“中”；若符合2个或更少条目，则为“低”。使用Cox模型进行分析，并对主要混杂因素进行了校正。共有55%的患者社交网络为高或中。在中位随访6.5个月期间，135例（36.4%）患者首次因急症再次入院，68例（18.3%）患者死亡。与社交网络高的患者相比，社交网络为中（风险比[HR] 1.87；95%置信区间[CI] 1.06 - 3.29；P < 0.05）和低的患者再次入院更为频繁（HR 1.98；95% CI 1.07 - 3.68；P < 0.05）。这种关系呈现出正剂量反应（线性趋势p值为0.042）。这种关联的强度与再次入院的其他重要预测因素（如既往住院史）相当。未观察到社交网络与死亡之间的关系。
一份非常简单的测量社交网络的问卷能够识别出短期再次入院风险较高的患者。
