McNeely Christian, Telila Tesfaye, Markwell Stephen, Hazelrigg Stephen, Vassileva Christina M
Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
J Heart Valve Dis. 2016 Jul;25(4):430-436.
Large-scale data of heart failure (HF) readmission after aortic valve replacement (AVR) are limited.
A total of 40,751 Medicare beneficiaries >65 years who underwent primary isolated AVR between 2000 and 2004 were included in the study. Preoperative HF was defined using ICD-9-CM diagnostic codes from the index admission and any hospitalization during the preceding year. Cumulative readmission incidences over five years were computed for those patients with and without preoperative HF, while adjusting for propensity scores.
The median patient age was 76 years. At 30 days, all-cause readmission was 21.5% and HF readmission was 3.9%. Patients with preoperative HF had higher postoperative HF readmission rates compared to those without (30 days, 6.3% versus 2.2%; one year, 13.9% versus 4.4%; five years, 6.6% versus 10.3%, p = 0.0001). The incremental risk of HF on readmission was >2 following adjustment. In patients with preoperative HF, the number of admissions was associated with increased postoperative HF readmissions. At 30 days, patients with no preoperative HF admissions had a HF readmission rate of 5.3%, while those with one, two, three and four or more preoperative HF admissions had rates of 8.2%, 11.9%, 13.8% and 17.4%, respectively. This trend persisted over the five-year follow up period.
Postoperative HF readmission accounted for about one-fifth of all-cause readmissions after AVR in Medicare beneficiaries. Preoperative HF significantly contributed to postoperative readmission, both all-cause and HF-specific, which likely limits the symptomatic benefit of surgery. These data support early aortic valve intervention prior to the development of clinically apparent HF.
主动脉瓣置换术（AVR）后心力衰竭（HF）再入院的大规模数据有限。
本研究纳入了2000年至2004年间接受初次单纯AVR的40751名65岁以上的医疗保险受益人。术前HF通过索引入院时以及前一年任何住院期间的ICD - 9 - CM诊断代码来定义。在调整倾向得分的同时，计算了有和没有术前HF的患者五年内的累积再入院发生率。
患者的中位年龄为76岁。在30天时，全因再入院率为21.5%，HF再入院率为3.9%。与无术前HF的患者相比，有术前HF的患者术后HF再入院率更高（30天时，6.3%对2.2%；一年时，13.9%对4.4%；五年时，6.6%对10.3%，p = 0.0001）。调整后，再入院时HF的增量风险>2。在有术前HF的患者中，入院次数与术后HF再入院增加相关。在30天时，无术前HF入院的患者HF再入院率为5.3%，而有一次、两次、三次以及四次或更多次术前HF入院的患者再入院率分别为8.2%、11.9%、13.8%和17.4%。这一趋势在五年随访期内持续存在。
在医疗保险受益人中，术后HF再入院占AVR后全因再入院的约五分之一。术前HF显著导致了全因和HF特异性的术后再入院，这可能限制了手术的症状改善益处。这些数据支持在临床明显HF发生之前尽早进行主动脉瓣干预。
