Internal Medicine, Hospital of Montepulciano, Italy.
Int J Cardiol. 2011 Oct 6;152(1):88-94. doi: 10.1016/j.ijcard.2011.02.025. Epub 2011 Mar 11.
Heart failure (HF) is a major health and social problem. Internal Medicine (IM) wards admit a high proportion of patients with HF, frequently with advanced age and comorbidities. Few recent data are available in this setting, especially on predictors of in-hospital outcome.
In this observational study, we recruited patients admitted with diagnosis of HF and present in five index days, in 91 units of IM in Italy. Characteristics and management of HF, comorbidities, functional and cognitive status, and quality of life, were analyzed.
We observed 1411 patients, with a mean age of 78.7 ± 9.6 years. At admission, 81.7% of the patients were in NYHA classes III-IV. Ninety percent of the patients had at least one comorbidity. Dementia or severely impaired functional status were registered in 21.5% and 22.8% of the patients. In 89 patients (6,3%) a negative outcome (death or clinical worsening) occurred during hospitalization. A number of variables were significantly related to negative outcome by means of univariate analysis (systolic blood pressure <100 mm Hg, pulse pressure ≥ 55 mm Hg, anaemia, brain deficit, permanent bed rest, Barthel Index ≤ 30). At multivariable analysis, significant correlation was retained by anaemia and Barthel Index ≤ 30, the latter being the strongest predictor.
Real-world patients with HF and hospitalized in IM are frequently very old, frail and with multiple comorbidities. Functional and cognitive status significantly influence patients' outcome, and this could lead to a rethinking of the overall (in-hospital but also home-based) management of HF.
心力衰竭（HF）是一个主要的健康和社会问题。内科（IM）病房收治了大量 HF 患者，这些患者通常年龄较大且合并多种疾病。在这种情况下，最近的数据很少，特别是关于住院期间结局的预测因素。
在这项观察性研究中，我们招募了因 HF 诊断而入院且在意大利 91 个内科病房中出现的 5 个指数日内的患者。分析了 HF、合并症、功能和认知状态以及生活质量的特征和管理。
我们观察了 1411 名患者，平均年龄为 78.7 ± 9.6 岁。入院时，81.7%的患者处于 NYHA 分级 III-IV 级。90%的患者至少有一种合并症。21.5%和 22.8%的患者有痴呆或严重功能障碍。在 89 名患者（6.3%）中，住院期间发生了不良结局（死亡或临床恶化）。一些变量通过单因素分析与不良结局显著相关（收缩压<100mmHg、脉压≥55mmHg、贫血、脑损伤、长期卧床、巴氏指数≤30）。多因素分析保留了贫血和巴氏指数≤30 与不良结局的显著相关性，后者是最强的预测因素。
在真实世界中，因 HF 住院的内科患者通常非常年老、体弱且合并多种疾病。功能和认知状态显著影响患者的结局，这可能导致对 HF 的整体（住院期间和家庭）管理进行重新思考。
