Linjer Erland, Jörnmark Jan, Hedner Thomas, Jönsson Bengt
Department of Clinical Pharmacology, Sahlgrenska University Hospital, Stockholm, Sweden.
Blood Press. 2006;15(4):245-50. doi: 10.1080/08037050600912237.
To analyse predictors of high cost of care in elderly hypertensive patients, in particular costs related to short-term (<10 days) and long-term (< or = 10 days) institutional care.
Health Economy (HE) sub-study in the Swedish Trial in Old Patients with Hypertension-2 (STOP Hypertension-2).
Outpatient clinics, hospitals and nursing homes in Sweden.
Elderly (70-84 years) patients (n=6614) from the STOP Hypertension-2 cohort with a systolic or diastolic hypertension, or a combination thereof, were included.
Costs of institutional care were analysed and categorized as short-term (<10 days or long-term care (> or = 10 days). Costs were related to individual patients and calculations were made during follow-up in STOP Hypertension-2 from inclusion to end of study. Data was available from 99% of all scheduled visits during the median 5.3 years of follow-up in the 6614 elderly hypertensive patients.
A multivariate analysis of potential predictors for inpatient short-term or long-term care demonstrated that several clinical factors within the groups of target organ damage (TOD), associated clinical conditions (ACC), as well as additional risk factors (RF) predicted for an increased probability of inpatient care in elderly hypertensives. Specifically, predictors for heart failure (OR 1.73, p=0.005), diabetes (OR 1.36, p<0.0005) and older age (OR 1.05, p<0.0001). Predictors at entry for long-term care (> or = 10 days) were; presence of ischaemic heart disease (OR 1.65, p<0.0001), diabetes mellitus (OR 1.32, p=0.012), female gender (OR 0.80, p=0.0003) as well as older age (OR 1.02, p=0.046). High total costs for this cohort of elderly hypertensive patients were recorded in the group subjected to long-term care for cardiovascular as well as non-cardiovascular reasons. Male gender (p=0.004) and stroke (p=0.06) remained predictors for high costs for hospital care while stroke (p<0.0001) and old age (p<0.0001) predicted for high costs for nursing home care.
In elderly hypertensives in STOP Hypertension-2, presence of cardiac disease, stroke, diabetes and older age at entry increased the probability as well as costs for both short- and long-term care. Level of systolic or diastolic blood pressure did not predict for hospitalization or cost outcome. Our results provide an economic argument for strict risk reduction focus in the management of elderly high-risk hypertensive patients.
分析老年高血压患者护理费用高昂的预测因素，尤其是与短期（<10天）和长期（≥10天）机构护理相关的费用。
瑞典老年高血压患者试验-2（STOP高血压-2）中的健康经济（HE）子研究。
瑞典的门诊诊所、医院和养老院。
纳入了STOP高血压-2队列中年龄在70 - 84岁、患有收缩期或舒张期高血压或两者皆有的患者（n = 6614）。
分析机构护理费用并分为短期（<10天）或长期护理（≥10天）。费用与个体患者相关，并在STOP高血压-2从纳入到研究结束的随访期间进行计算。在6614名老年高血压患者中位5.3年的随访期间，99%的预定就诊数据可用。
对住院短期或长期护理潜在预测因素的多变量分析表明，靶器官损害（TOD）组、相关临床病症（ACC）组以及其他风险因素（RF）中的几个临床因素预测老年高血压患者住院护理概率增加。具体而言，心力衰竭（比值比1.73，p = 0.005）、糖尿病（比值比1.36，p < 0.0005）和高龄（比值比1.05，p < 0.0001）是预测因素。长期护理（≥10天）入院时的预测因素为：存在缺血性心脏病（比值比1.65，p < 0.0001）、糖尿病（比值比1.32，p = 0.012）、女性（比值比0.80，p = 0.0003）以及高龄（比值比1.02，p = 0.046）。该组老年高血压患者因心血管及非心血管原因接受长期护理的费用最高。男性（p = 0.004）和中风（p = 0.06）仍是医院护理费用高昂的预测因素，而中风（p < 0.0001）和高龄（p < 0.0001）预测养老院护理费用高昂。
在STOP高血压-2的老年高血压患者中，入院时存在心脏病、中风、糖尿病和高龄会增加短期和长期护理的概率及费用。收缩压或舒张压水平不能预测住院情况或费用结果。我们的结果为在老年高危高血压患者管理中严格关注风险降低提供了经济依据。
