Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Am J Cardiol. 2013 Jan 1;111(1):79-84. doi: 10.1016/j.amjcard.2012.08.050. Epub 2012 Oct 2.
The aim of the present study was to evaluate whether diagnostic data collected after a heart failure (HF) hospitalization can identify patients with HF at risk of early readmission. The diagnostic data from cardiac resynchronization therapy defibrillator (CRT-D) devices can identify outpatient HF patients at risk of future HF events. In the present retrospective analysis of 4 studies, we identified patients with CRT-D devices, with a HF admission, and 30-day postdischarge follow-up data. The evaluation of the diagnostic data for impedance, atrial fibrillation, ventricular heart rate during atrial fibrillation, loss of CRT-D pacing, night heart rate, and heart rate variability was modeled to simulate a review of the first 7 days after discharge on the seventh day. Using a combined score created from the device parameters that were significant univariate predictors of 30-day HF readmission, 3 risk groups were created. A Cox proportional hazards model adjusting for age, gender, New York Heart Association class, and length of stay during the index hospitalization was used to compare the groups. The study cohort of 166 patients experienced a total of 254 HF hospitalizations, with 34 readmissions within 30 days. Daily impedance, high atrial fibrillation burden with poor rate control (>90 beat/min) or reduced CRT-D pacing (<90% pacing), and night heart rate >80 beats/min were significant univariate predictors of 30-day HF readmission. Patients in the "high"-risk group for the combined diagnostic had a significantly greater risk (hazard ratio 25.4, 95% confidence interval 3.6 to 179.0, p = 0.001) compared to the "low"-risk group for 30-day readmission for HF. In conclusion, device-derived HF diagnostic criteria evaluated 7 days after discharge identified patients at significantly greater risk of a HF event within 30 days after discharge.
本研究旨在评估心力衰竭（HF）住院后收集的诊断数据是否可以识别 HF 再入院风险较高的患者。心脏再同步治疗除颤器（CRT-D）设备中的诊断数据可以识别未来 HF 事件风险较高的门诊 HF 患者。在本研究回顾性分析的 4 项研究中，我们确定了 CRT-D 设备、HF 入院和 30 天出院后随访数据的患者。对阻抗、心房颤动、心房颤动期间心室率、CRT-D 起搏丢失、夜间心率和心率变异性的诊断数据进行评估，以模拟出院后第 7 天对前 7 天的审查。使用从设备参数创建的综合评分，这些参数是 30 天 HF 再入院的单变量预测因素，创建了 3 个风险组。使用调整年龄、性别、纽约心脏协会（NYHA）分级和指数住院期间住院时间的 Cox 比例风险模型对组间进行比较。共有 166 例患者的研究队列经历了 254 次 HF 住院，其中 34 次在 30 天内再入院。每日阻抗、高心房颤动负荷伴较差的心率控制（>90 次/分钟）或 CRT-D 起搏减少（<90%起搏）以及夜间心率>80 次/分钟是 30 天 HF 再入院的显著单变量预测因素。与低风险组相比，联合诊断“高”风险组患者在 30 天内 HF 再入院的风险显著增加（风险比 25.4，95%置信区间 3.6 至 179.0，p = 0.001）。结论：出院后 7 天评估的设备衍生 HF 诊断标准可识别出院后 30 天内 HF 事件风险显著增加的患者。
