2002 至 2006 年期间，退伍军人事务部医疗体系中心衰住院患者的生存率和再入院率呈发散趋势。

Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs health care system 2002 to 2006.

机构信息

VA Palo Alto Health Care System, Palo Alto, California 94304, USA.

出版信息

J Am Coll Cardiol. 2010 Jul 27;56(5):362-8. doi: 10.1016/j.jacc.2010.02.053.

DOI:10.1016/j.jacc.2010.02.053

PMID:20650356

Abstract

OBJECTIVES

This study sought to determine recent trends over time in heart failure hospitalization, patient characteristics, treatment, rehospitalization, and mortality within the Veterans Affairs health care system.

BACKGROUND

Use of recommended therapies for heart failure has increased in the U.S. However, it is unclear to what extent hospitalization rates and the associated mortality have improved.

METHODS

We compared rates of hospitalization for heart failure, 30-day rehospitalization for heart failure, and 30-day mortality following discharge from 2002 to 2006 in the Veterans Affairs Health Care System. Odds ratios for outcome were adjusted for patient diagnoses within the past year, laboratory data, and for clustering of patients within hospitals.

RESULTS

We identified 50,125 patients with a first hospitalization for heart failure from 2002 to 2006. Mean age did not change (70 years), but increases were noted for most comorbidities (mean Charlson score increased from 1.72 to 1.89, p < 0.0001). Heart failure admission rates remained constant at about 5 per 1,000 veterans. Mortality at 30 days decreased (7.1% to 5.0%, p < 0.0001), whereas rehospitalization for heart failure at 30 days increased (5.6% to 6.1%, p = 0.11). After adjustment for patient characteristics, the odds ratio for rehospitalization in 2006 (vs. 2002) was 0.54 (95% confidence interval [CI]: 0.47 to 0.61) for mortality, but 1.21 (95% CI: 1.04 to 1.41) for heart failure rehospitalization at 30 days.

CONCLUSIONS

Recent mortality and rehospitalization rates in the Veterans Affairs Health Care System have trended in opposite directions. These results have implications for using rehospitalization as a measure of quality of care.

摘要

目的

本研究旨在确定退伍军人事务部医疗保健系统中心衰住院、患者特征、治疗、再住院和死亡率随时间的近期趋势。

背景

美国推荐用于心衰的疗法的使用有所增加。然而，住院率和相关死亡率改善的程度尚不清楚。

方法

我们比较了退伍军人事务部医疗保健系统 2002 年至 2006 年期间心衰住院率、心衰 30 天再住院率和出院后 30 天死亡率。调整了患者过去一年的诊断、实验室数据和患者在医院内的聚类情况，对结果的比值比进行了调整。

结果

我们从 2002 年至 2006 年共确定了 50125 例首次心衰住院患者。平均年龄没有变化（70 岁），但大多数合并症的发生率都有所增加（平均 Charlson 评分从 1.72 增加到 1.89，p<0.0001）。心衰入院率保持在每千名退伍军人约 5 例。30 天死亡率降低（7.1%降至 5.0%，p<0.0001），而 30 天心衰再住院率增加（5.6%升至 6.1%，p=0.11）。在调整了患者特征后，2006 年（与 2002 年相比）再住院的比值比为 0.54（95%置信区间：0.47 至 0.61），但 30 天心衰再住院的比值比为 1.21（95%置信区间：1.04 至 1.41）。