Freimark Dov, Arad Michael, Matetzky Shlomi, DeNeen Isabell, Gershovitz Liron, Morag Nira Koren, Hochberg Naomi, Makmal Yafit, Shechter Michael
Heart Failure Service, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2009 Jul;11(7):419-25.
Chronic heart failure is associated with excessive hospitalizations and poor prognosis.
To summarize the 5 year experience of a single-center CHF day care service, detect the cardiovascular and non-cardiovascular events, and evaluate the safety of the treatments provided.
We retrospectively studied all patients admitted to the CHF day care service of the Sheba Medical Center between September 2000 and September 2005.
Advanced (New York Heart Association class III-IV) CHF patients (n = 190), mean age 65 +/- 12 years and left ventricular ejection fraction 25 +/- 11%, were treated for 6 hourly biweekly visits; 77% had ischemic and 23% had nonischemic cardiomyopathy. Treatment included: intravenous diuretic combinations (91%), intermittent low dose (< or = 5 microg/kg/min) dobutamine (87%), low dose (< or = 3 microg/kg/min) dopamine (38%), intravenous iron preparation and/or blood (47%), and intravenous nitropruside (36%). Follow-up of at least 1 year from initiation of therapy was completed in 158 of 190 patients (83%). Forty-six (29.3%) died: 23% due to CHF exacerbation, 5.7% from infection, 4.4% from sudden cardiac death, 3.8% from malignancy, 2.5% from malignant arrhythmias, 1.9% from renal failure, 1.3% from stroke, and 0.6% from myocardial infarction. There were only 0.68 rehospitalizations/patient/year; the most frequent cause being CHF exacerbation (16.5%).
Our study demonstrates the safety and potential benefits of a supportive day care service for advanced CHF patients. Multidrug intravenous treatment, accompanied by monitoring of electrolytes, hemoglobin and cardiac rhythm, along with education and psychological support, appear to reduce morbidity in advanced CHF patients and may have contributed to the lower than expected mortality/ hospitalization rate.
慢性心力衰竭与住院次数过多及预后不良相关。
总结单中心慢性心力衰竭日间护理服务的5年经验，检测心血管和非心血管事件，并评估所提供治疗的安全性。
我们回顾性研究了2000年9月至2005年9月期间入住舍巴医疗中心慢性心力衰竭日间护理服务的所有患者。
晚期（纽约心脏病协会III-IV级）慢性心力衰竭患者（n = 190），平均年龄65±12岁，左心室射血分数25±11%，每两周接受6次每小时一次的治疗；77%患有缺血性心肌病，23%患有非缺血性心肌病。治疗包括：静脉用利尿剂联合治疗（91%）、间歇性低剂量（≤5微克/千克/分钟）多巴酚丁胺（87%）、低剂量（≤3微克/千克/分钟）多巴胺（38%）、静脉用铁制剂和/或输血（47%）以及静脉用硝普钠（36%）。190例患者中有158例（83%）完成了从治疗开始至少1年的随访。46例（29.3%）死亡：23%死于慢性心力衰竭加重，5.7%死于感染，4.4%死于心源性猝死，3.8%死于恶性肿瘤，2.5%死于恶性心律失常，1.9%死于肾衰竭，1.3%死于中风，0.6%死于心肌梗死。每位患者每年的再住院率仅为0.68次；最常见的原因是慢性心力衰竭加重（16.5%）。
我们的研究证明了为晚期慢性心力衰竭患者提供支持性日间护理服务的安全性和潜在益处。多药静脉治疗，同时监测电解质、血红蛋白和心律，以及进行教育和心理支持，似乎可以降低晚期慢性心力衰竭患者的发病率，并且可能是死亡率/住院率低于预期的原因。
