Jois-Bilowich Preeti, Michota Frank, Bartholomew John R, Glauser Jonathan, Diercks Deborah, Weber James, Fonarow Gregg C, Emerman Charles L, Peacock W Frank
Preeti Jois-Bilowich, Department of Emergency Medicine, Desk E-19, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
J Card Fail. 2008 Mar;14(2):127-32. doi: 10.1016/j.cardfail.2007.10.017.
Venous thromboembolism (VTE) is a concerning problem for hospitalized heart failure (HF) patients. Current recommendations are that all hospitalized New York Heart Association Class III or IV HF patients should receive VTE prophylaxis. Our purpose was to describe the rate of use and the characteristics of patients receiving VTE prophylaxis in the Acute Decompensated Heart Failure National Registry (ADHERE).
HF hospitalization episodes in ADHERE were analyzed. Patients were excluded from analysis if they were receiving Coumadin or intravenous heparin, had elevated troponin levels, underwent cardiac catheterization or dialysis before or during hospitalization, or were initially admitted to the intensive care unit. VTE prophylaxis was defined as low-molecular-weight or subcutaneous unfractionated heparin administered at any time during hospitalization and intravenous vasoactive therapy was defined as any inotrope, inodilator, or vasodilator. Chi-square, analysis of variance, and Wilcoxon tests were used for univariate and multivariate analyses. Logistic regression was used to evaluate outcomes. A total of 155,073 entries were evaluated, with 71,376 eligible for VTE prophylaxis; 21,847 (31%) received VTE prophylaxis. VTE prophylaxis patients were more often African American (28% versus 21%) or admitted from the emergency department (84% versus 79%), compared with those who did not receive VTE prophylaxis (both P < .0001). Medical history and initial presentation characteristics were similar, except edema, which was more likely in VTE prophylaxis patients (71% versus 66%, P < .0001). Patients receiving VTE prophylaxis more often received an intravenous vasoactive agent (23% versus 18%), angiotensin-converting enzyme inhibitor (61% versus 54%), or beta-blocker (63% versus 58%) during their hospitalization and were more likely discharged on an angiotensin-converting enzyme inhibitor (53% versus 49%) or beta-blocker (57% versus 54%) than non-VTE prophylaxis patients, all P < .0001. VTE prophylaxis patients were more often admitted to the intensive care unit (4.8% versus 2.5%, P < .0001) and had longer median hospital stays (4.2 versus 3.8 days, P < .0001). Mortality was similar between cohorts (3.0% versus 2.9%, P = .69).
Despite recommendations that all hospitalized New York Heart Association III and IV CHF patients receive venous thromboembolic disease prophylaxis, less than one third of eligible patients receive this guideline recommended therapy.
静脉血栓栓塞症（VTE）是住院心力衰竭（HF）患者面临的一个重要问题。目前的建议是，所有住院的纽约心脏协会III级或IV级HF患者都应接受VTE预防。我们的目的是描述急性失代偿性心力衰竭国家注册研究（ADHERE）中接受VTE预防的患者的使用率和特征。
对ADHERE中的HF住院病例进行分析。如果患者正在接受华法林或静脉肝素治疗、肌钙蛋白水平升高、在住院前或住院期间接受过心脏导管插入术或透析，或最初入住重症监护病房，则将其排除在分析之外。VTE预防定义为住院期间任何时间给予的低分子量或皮下普通肝素，静脉血管活性治疗定义为任何正性肌力药物、血管扩张剂或血管舒张剂。卡方检验、方差分析和Wilcoxon检验用于单变量和多变量分析。逻辑回归用于评估结果。共评估了155,073条记录，其中71,376条符合VTE预防条件；21,847例（31%）接受了VTE预防。与未接受VTE预防的患者相比，接受VTE预防的患者更常为非裔美国人（28%对21%）或从急诊科入院（84%对79%）（均P <.0001）。病史和初始表现特征相似，但水肿在接受VTE预防的患者中更常见（71%对66%，P <.0001）。接受VTE预防的患者在住院期间更常接受静脉血管活性药物（23%对18%）、血管紧张素转换酶抑制剂（61%对54%）或β受体阻滞剂（63%对58%），并且比未接受VTE预防的患者更有可能出院时使用血管紧张素转换酶抑制剂（53%对49%）或β受体阻滞剂（57%对54%），所有P <.0001。接受VTE预防的患者更常入住重症监护病房（4.8%对2.5%，P <.0001），中位住院时间更长（4.2天对3.8天，P <.0001）。两组之间的死亡率相似（3.0%对2.9%，P =.69）。
尽管建议所有住院的纽约心脏协会III级和IV级CHF患者接受静脉血栓栓塞性疾病预防，但不到三分之一的符合条件的患者接受了该指南推荐的治疗。
