Hummel Scott L, DeFranco Anthony C, Skorcz Stephen, Montoye Cecelia K, Koelling Todd M
Division of Cardiovascular Medicine, University of Michigan Department of Internal Medicine, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, MI 48109, USA.
Am J Med. 2009 Nov;122(11):1029-36. doi: 10.1016/j.amjmed.2009.04.025.
Dietary sodium indiscretion frequently contributes to hospitalizations in elderly heart failure patients. Animal models suggest an important role for dietary sodium intake in the pathophysiology of heart failure with preserved systolic function. The documentation and effects of hospital discharge recommendations, particularly for sodium-restricted diet, have not been extensively investigated in heart failure with preserved systolic function.
We analyzed 1700 heart failure admissions to Michigan community hospitals. We compared documentation of guideline-based discharge recommendations between preserved systolic function and systolic heart failure patients with chi-squared testing, and used logistic regression to identify predictors of 30-day death and hospital readmission in a prespecified follow-up cohort of 443 patients with preserved systolic function. We hypothesized that patients who received a documented discharge recommendation for sodium-restricted diet would have lower 30-day adverse event rates.
Heart failure patients with preserved systolic function were significantly less likely than systolic heart failure patients to receive discharge recommendations for weight monitoring (33% vs 43%) and sodium-restricted diet (42% vs 53%). Upon propensity score-adjusted multivariable analysis, patients with preserved systolic function who received a documented sodium-restricted diet recommendation had decreased odds of 30-day combined death and readmission (odds ratio 0.43, 95% confidence interval, 0.24-0.79; P=.007). No other discharge recommendations predicted 30-day outcomes.
Clinicians document appropriate discharge instructions less frequently in heart failure with preserved systolic function than systolic heart failure. Selected heart failure patients with preserved systolic function who receive advice for sodium-restricted diet may have improved short-term outcomes after hospital discharge.
饮食中钠摄入不当常常导致老年心力衰竭患者住院。动物模型表明，饮食中钠摄入在收缩功能保留的心力衰竭病理生理学中起重要作用。对于收缩功能保留的心力衰竭患者，出院建议（尤其是限钠饮食建议）的记录情况及效果尚未得到广泛研究。
我们分析了密歇根社区医院1700例心力衰竭住院病例。我们采用卡方检验比较了收缩功能保留的患者与收缩性心力衰竭患者基于指南的出院建议记录情况，并使用逻辑回归分析在一个预先设定的包含443例收缩功能保留患者的随访队列中确定30天死亡和再入院的预测因素。我们假设，收到限钠饮食书面出院建议的患者30天不良事件发生率会更低。
收缩功能保留的心力衰竭患者比收缩性心力衰竭患者接受体重监测出院建议（33%对43%）和限钠饮食出院建议（42%对53%）的可能性显著更低。经过倾向评分调整的多变量分析，收到限钠饮食书面建议的收缩功能保留患者30天死亡和再入院合并发生率降低（比值比0.43，95%置信区间，0.24 - 0.79；P = 0.007）。没有其他出院建议能够预测30天的转归情况。
与收缩性心力衰竭相比，临床医生对收缩功能保留的心力衰竭患者记录适当出院指导的频率更低。部分收到限钠饮食建议的收缩功能保留的心力衰竭患者出院后短期转归可能改善。
