Joshua F. Wiley, PhD Postdoctoral Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Yih-Kai Chan, PhD Research Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Yasmin Ahamed, PhD Postdoctoral Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Jocasta Ball, PhD NHMRC/NHFA Early Career Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Melinda J. Carrington, PhD Associate Professor, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Barbara Riegel, PhD Professor, University of Pennsylvania School of Nursing, Philadelphia. Simon Stewart, PhD Director, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
J Cardiovasc Nurs. 2018 Sep/Oct;33(5):437-445. doi: 10.1097/JCN.0000000000000391.
Multimorbidity has an adverse effect on health outcomes in hospitalized individuals with chronic heart failure (CHF), but the modulating effect of multidisciplinary management is unknown.
The aim of this study was to test the hypothesis that increasing morbidity would independently predict an increasing risk of 30-day readmission despite multidisciplinary management of CHF.
We studied patients hospitalized for any reason with heart failure receiving nurse-led, postdischarge multidisciplinary management. We profiled a matrix of expected comorbidities involving the most common coexisting conditions associated with CHF and examined the relationship between multimorbidity and 30-day all-cause readmission.
A total of 830 patients (mean age 73 ± 13 years and 65% men) were assessed. Multimorbidity was common, with an average of 6.6 ± 2.4 comorbid conditions with sex-based differences in prevalence of 4 of 10 conditions. Within 30 days of initial hospitalization, 216 of 830 (26%) patients were readmitted for any reason. Greater multimorbidity was associated with increasing readmission (4%-44% for those with 0-1 to 8-9 morbid conditions; adjusted odds ratio, 1.25; 95% confidence interval, 1.13-1.38) for each additional condition. Three distinct classes of patient emerged: class 1-diabetes, metabolic, and mood disorders; class 2-renal impairment; and class 3-low with relatively fewer comorbid conditions. Classes 1 and 2 had higher 30-day readmission than class 3 did (adjusted P < .01 for both comparisons).
These data affirm that multimorbidity is common in adult CHF inpatients and in potentially distinct patterns linked to outcome. Overall, greater multimorbidity is associated with a higher risk of 30-day all-cause readmission despite high-quality multidisciplinary management. More innovative approaches to target-specific clusters of multimorbidity are required to improve health outcomes in affected individuals.
多种合并症会对慢性心力衰竭（CHF）住院患者的健康结果产生不利影响，但多学科管理的调节作用尚不清楚。
本研究旨在检验以下假设，即尽管对 CHF 进行了多学科管理，但合并症的增加仍会独立预测 30 天再入院的风险增加。
我们研究了因任何原因住院的心力衰竭患者，他们接受了护士主导的、出院后的多学科管理。我们对涉及与 CHF 最常见并存疾病的预期合并症矩阵进行了分析，并检查了多种合并症与 30 天全因再入院之间的关系。
共评估了 830 例患者（平均年龄 73 ± 13 岁，65%为男性）。合并症很常见，平均有 6.6 ± 2.4 种合并症，10 种合并症中有 4 种在男性中的患病率存在性别差异。在初次住院后 30 天内，830 例患者中有 216 例（26%）因任何原因再次入院。合并症越多，再入院的风险就越高（0-1 种与 8-9 种合并症的患者再入院率分别为 4%-44%；调整后的优势比为 1.25；95%置信区间为 1.13-1.38），每增加一种合并症。出现了 3 种不同类型的患者：第 1 类-糖尿病、代谢和情绪障碍；第 2 类-肾功能损害；第 3 类-合并症较少的低危。第 1 类和第 2 类患者的 30 天再入院率高于第 3 类（两者比较的调整 P 值均<.01）。
这些数据证实，多种合并症在成年 CHF 住院患者中很常见，且存在与结局相关的潜在不同模式。总的来说，尽管进行了高质量的多学科管理，多种合并症的增加与 30 天全因再入院的风险增加相关。需要更具创新性的方法针对特定的多种合并症群，以改善受影响个体的健康结局。
