New York Medical College, Valhalla, NY, USA.
J Am Med Dir Assoc. 2012 Jun;13(5):448-52. doi: 10.1016/j.jamda.2011.09.001. Epub 2011 Oct 8.
To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF).
Hospitalized NH residents (n = 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998-2001.
Observational. MEASUREMENTS OF EVIDENCE-BASED CARE: Preadmission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n = 494), in-hospital LVEF estimation for HF patients without known LVEF (n = 452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs or ARBs) to systolic HF (LVEF <45%) patients discharged alive who were eligible to receive those drugs (n = 83). Eligibility for ACEIs or ARBs was defined as lack of prior allergy or adverse effect, serum creatinine lower than 2.5 mg/dL, serum potassium lower than 5.5 mEq/L, and systolic blood pressure higher than 100 mm Hg.
Preadmission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio [AOR], 3.49; 95% CI, 2.16-5.66; P < .001). In-hospital LVEF was estimated in 71% and 28% of patients receiving and not receiving cardiology consultation, respectively (AOR, 6.01; 95% CI, 3.69-9.79; P < .001). ACEIs or ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07-0.81; P = .022).
In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF; however, it did not translate into higher odds of discharge prescriptions for ACEIs or ARBs to NH residents with systolic HF who were eligible for the receipt of these drugs.
确定心脏病学咨询与循证护理在养老院（NH）心力衰竭（HF）患者中的关联。
1998-2001 年期间，从阿拉巴马州 106 家医院出院的患有 HF 的 NH 住院患者（n = 646），其主要出院诊断为 HF。
观察性研究。循证护理的测量：已知 HF 患者的左心室射血分数（LVEF）的入院前估计（n = 494），无已知 LVEF 的 HF 患者的住院期间 LVEF 估计（n = 452），以及出院时活存且有资格接受这些药物的收缩性 HF（LVEF <45%）患者的血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEI 或 ARB）处方（n = 83）。ACEI 或 ARB 的资格定义为无既往过敏或不良反应史，血清肌酐低于 2.5mg/dL，血清钾低于 5.5mEq/L，收缩压高于 100mmHg。
接受和未接受心脏病学咨询的患者中，入院前 LVEF 的估计分别为 38%和 12%（调整后的优势比[OR]，3.49；95%CI，2.16-5.66；P <.001）。接受和未接受心脏病学咨询的患者中，住院期间 LVEF 的估计分别为 71%和 28%（OR，6.01；95%CI，3.69-9.79；P <.001）。ACEI 或 ARB 处方分别给予接受和未接受心脏病学咨询的患者的 62%和 82%（OR，0.24；95%CI，0.07-0.81；P =.022）。
NH 心力衰竭患者住院期间的心脏病学咨询与 LVEF 估计的可能性显著增加有关；然而，这并没有转化为对有资格接受这些药物的收缩性 HF 的 NH 居民开出 ACEI 或 ARB 的可能性增加。
