Dharmarajan Kumar, Hsieh Angela, Dreyer Rachel P, Welsh Jack, Qin Li, Krumholz Harlan M
Section of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
J Am Geriatr Soc. 2017 Feb;65(2):421-426. doi: 10.1111/jgs.14583. Epub 2016 Nov 22.
To characterize the magnitude and duration of risk of rehospitalization according to age after hospitalization for heart failure (HF), acute myocardial infarction (AMI), or pneumonia.
Retrospective cohort study.
U.S. hospitals (n = 4,767).
All Medicare fee-for-service beneficiaries aged 65 and older surviving hospitalization for HF, AMI, or pneumonia between October 2012 and December 2013.
Daily risk of first rehospitalization for 1 year after hospital discharge was calculated according to age category (65-74, 75-84, ≥85) after adjustment for sex, race, comorbidities, and median ZIP code income. Time required for adjusted rehospitalization risk to decline 50% from maximum value after discharge, time required for adjusted risk to approach a plateau period of minimal day-to-day change, and degree to which adjusted risk was higher in recently hospitalized individuals than in the general elderly population were identified.
There were 414,720 hospitalizations for HF, 177,752 for AMI, and 568,304 for pneumonia. The adjusted risk of rehospitalization declined with increasing age after HF hospitalization (P < .001), rose with increasing age after AMI hospitalization (P < .001), and was slightly lower with increasing age after pneumonia hospitalization (P = .002). Adjusted risks of rehospitalization were high beyond 30 days after hospitalization for all ages.
Although older age has heterogeneous relationships with rehospitalization risk, risk of readmission remains high for an extended time after discharge regardless of age or admitting condition. Condition-specific data on risk can be used to guide discussions on advanced care planning and strategies for longitudinal follow-up after hospitalization.
根据年龄特征描述心力衰竭（HF）、急性心肌梗死（AMI）或肺炎住院后再住院风险的大小和持续时间。
回顾性队列研究。
美国医院（n = 4767）。
2012年10月至2013年12月期间因HF、AMI或肺炎住院存活的所有65岁及以上的医疗保险按服务收费受益人。
出院后1年内首次再住院的每日风险根据年龄类别（65 - 74岁、75 - 84岁、≥85岁）进行计算，并对性别、种族、合并症和邮政编码收入中位数进行调整。确定出院后调整后的再住院风险从最大值下降50%所需的时间、调整后的风险接近每日变化最小的平稳期所需的时间，以及近期住院个体的调整后风险比一般老年人群高的程度。
HF住院414720例，AMI住院177752例，肺炎住院568304例。HF住院后，调整后的再住院风险随年龄增加而下降（P < 0.001），AMI住院后随年龄增加而上升（P < 0.001），肺炎住院后随年龄增加略有下降（P = 0.002）。所有年龄段住院后30天以上的调整后再住院风险都很高。
尽管年龄与再住院风险的关系具有异质性，但无论年龄或入院情况如何，出院后再入院风险在较长时间内仍然很高。特定疾病的风险数据可用于指导关于临终关怀规划的讨论以及住院后长期随访的策略。
