Small Roy S, Whellan David J, Boyle Andrew, Sarkar Shantanu, Koehler Jodi, Warman Eduardo N, Abraham William T
Eur J Heart Fail. 2014 Apr;16(4):419-25. doi: 10.1002/ejhf.48.
We hypothesized that diagnostic data in implantable devices evaluated on the day of discharge from a heart failure hospitalization (HFH) can identify patients at risk for HF readmission (HFR) within 30 days.
In this retrospective analysis of four studies enrolling patients with CRT devices, we identified patients with a HFH, device data on the day of discharge, and 30-day post-discharge clinical follow-up. Four diagnostic criteria were evaluated on the discharge day: (i) intrathoracic impedance>8 Ω below reference impedance; (ii) AF burden>6 h; (iii) CRT pacing<90%; and (iv) night heart rate>80 b.p.m. Patients were considered to have higher risk for HFR if ≥2 criteria were met, average risk if 1 criterion was met, and lower risk if no criteria were met. A Cox proportional hazards model was used to compare the groups. The data cohort consisted of a total of 265 HFHs in 175 patients, of which 36 (14%) were followed by HFR. On the discharge day, ≥2 criteria were met in 43 (16% of 265 HFHs), only 1 criterion was met in 92 (35%), and none of the four criteria were met in 130 HFHs (49%); HFR rates were 28, 16, and 7%, respectively. HFH with ≥2 criteria met was five times more likely to have HFR compared with HFH with no criteria met (adjusted hazard ratio 5.0; 95% confidence interval 1.9–13.5, P=0.001).
Device-derived diagnostic criteria evaluated on the day of discharge identified patients at significantly higher risk of HFR.
我们假设，在因心力衰竭住院（HFH）出院当天评估的植入式设备诊断数据能够识别出30天内有心力衰竭再入院（HFR）风险的患者。
在这项对四项纳入CRT设备患者的研究的回顾性分析中，我们确定了患有HFH、出院当天的设备数据以及出院后30天临床随访情况的患者。在出院当天评估了四项诊断标准：（i）胸腔内阻抗低于参考阻抗8Ω以上；（ii）房颤负荷>6小时；（iii）CRT起搏<90%；（iv）夜间心率>80次/分钟。如果满足≥2条标准，则认为患者HFR风险较高；满足1条标准则为平均风险；若未满足任何标准，则风险较低。使用Cox比例风险模型对各组进行比较。数据队列共包括175例患者中的265次HFH，其中36例（14%）随后发生HFR。在出院当天，43例（265次HFH中的16%）满足≥2条标准，92例（35%）仅满足1条标准，130次HFH（49%）未满足任何四条标准；HFR发生率分别为28%、16%和7%。满足≥2条标准的HFH发生HFR的可能性是未满足任何标准的HFH的五倍（调整后风险比5.0；95%置信区间1.9 - 13.5，P = 0.001）。
出院当天评估的设备衍生诊断标准可识别出HFR风险显著更高的患者。
