一项针对心力衰竭的综合医院-初级保健项目的疗效：对56742名患者的基于人群的分析。

Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients.

作者信息

Comín-Colet Josep, Verdú-Rotellar José María, Vela Emili, Clèries Montse, Bustins Montserrat, Mendoza Lola, Badosa Neus, Cladellas Mercè, Ferré Sofía, Bruguera Jordi

机构信息

Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.

Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Atención Primaria Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain; Institut d'Investigació d'Atenció Primària Jordi Gol, Institut Català de la Salut, Barcelona, Spain.

出版信息

Rev Esp Cardiol (Engl Ed). 2014 Apr;67(4):283-93. doi: 10.1016/j.rec.2013.12.005. Epub 2014 Feb 8.

DOI:10.1016/j.rec.2013.12.005

PMID:24774591

Abstract

INTRODUCTION AND OBJECTIVES

The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309,345.

METHODS

For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service).

RESULTS

We included 56,742 patients in the study. There were 181,204 hospital admissions and 30,712 deaths during the study period. In the adjusted analyses, when compared to the 54,659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established.

CONCLUSIONS

The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.

摘要

引言与目的

心力衰竭项目的疗效已在临床试验中得到证实，但其在实际临床实践中的适用性仍存在较多争议。本研究评估了一项综合医院 - 基层医疗项目在一个覆盖309,345人口的综合健康区域管理心力衰竭患者的可行性和疗效。

方法

为进行分析，我们纳入了2005年至2011年（该项目实施期间）在西班牙加泰罗尼亚所有医院以心力衰竭作为主要诊断且存活出院的所有连续入院患者，并将参与该项目患者的死亡率和再入院率与加泰罗尼亚卫生服务机构（Servei Català de la Salut）所有其他综合健康区域患者的相应比率进行比较。

结果

本研究共纳入56,742例患者。研究期间共有181,204次住院，30,712例死亡。在调整分析中，与来自其他健康区域的54,659例患者相比，参与该项目的2083例患者死亡风险较低（风险比 = 0.92 [95%置信区间，0.86 - 0.97]；P = 0.005），临床相关再入院风险较低（风险比 = 0.71 [95%置信区间，0.66 - 0.76]；P < 0.001），心力衰竭再入院风险较低（风险比 = 0.86 [95%置信区间，0.80 - 0.94]；P < 0.001）。该项目成熟后，对发病率和死亡率的积极影响更为显著。