Heidenreich Paul A, Fonarow Gregg C
VA Palo Alto Health Care System, Palo Alto, CA, USA.
Am Heart J. 2006 Nov;152(5):935-9. doi: 10.1016/j.ahj.2006.06.037.
Clinical registries have been created to address questions that are difficult to answer with clinical trials. However, the applicability of registry findings to the general population has been questioned because of concerns over potential bias in the selection of participating hospitals. The purpose of this study was to determine if patients admitted to hospitals participating in a heart failure registry (ADHERE) are comparable with patients admitted to other hospitals, including those admitted to Framingham area hospitals.
We used a 20% random sample of all Medicare patients discharged during 1984 to 2001 to determine rates of hospitalization, procedure use, and survival after a first admission for heart failure (none in the prior 3 years). Hospitals were classified as participating in the ADHERE registry (n = 189), located within or near Framingham, MA (n = 9), or other (n = 5541).
A total of 725,702 first admissions were identified, including 80,338 to ADHERE hospitals and 1716 to Framingham area hospitals. Minimal differences in patient characteristics were noted between patients admitted to ADHERE and non-ADHERE hospitals, although patients admitted to Framingham area hospitals were more likely to be white (95%) than were patients admitted to ADHERE (84%) or other hospitals (87%, P < .0001). Mortality at 1 year was 35.8% for ADHERE, 36.2% for other hospitalized patients, and 32.9% for Framingham patients (P < .0001). Rehospitalization for heart failure at 90 days was 13.0% for following admission to ADHERE, 13.0% to other hospitals, and 16.4% to Framingham hospitals (P = .0004). After adjustment for patient characteristics, differences in outcome between ADHERE and non-ADHERE hospitals remained minimal.
Patients admitted with heart failure to ADHERE registry hospitals had similar baseline characteristics and outcomes to other patients.
临床登记系统的建立是为了解决一些临床试验难以回答的问题。然而，由于担心参与登记的医院在选择过程中存在潜在偏差，登记结果对一般人群的适用性受到了质疑。本研究的目的是确定入住参与心力衰竭登记系统（ADHERE）的医院的患者与入住其他医院（包括入住弗雷明汉地区医院的患者）的患者是否具有可比性。
我们使用了1984年至2001年期间所有医疗保险出院患者的20%随机样本，以确定首次因心力衰竭入院（之前3年内无心力衰竭病史）后的住院率、手术使用率和生存率。医院被分为参与ADHERE登记系统的医院（n = 189）、位于马萨诸塞州弗雷明汉或其附近的医院（n = 9）或其他医院（n = 5541）。
共确定了725,702例首次入院病例，其中80,338例入住ADHERE登记系统的医院，1716例入住弗雷明汉地区医院。入住ADHERE登记系统的医院和未入住该系统的医院患者的特征差异极小，不过入住弗雷明汉地区医院的患者中白人比例（95%）高于入住ADHERE登记系统的医院患者（84%）或其他医院患者（87%，P <.0001）。ADHERE登记系统的医院患者1年死亡率为35.8%，其他住院患者为36.2%，弗雷明汉地区医院患者为32.9%（P <.0001）。入住ADHERE登记系统的医院后90天因心力衰竭再次住院率为13.0%，入住其他医院为13.0%，入住弗雷明汉地区医院为16.4%（P =.0004）。在对患者特征进行调整后，ADHERE登记系统的医院和未入住该系统的医院在结局方面的差异仍然极小。
因心力衰竭入住ADHERE登记系统医院的患者与其他患者具有相似的基线特征和结局。
