Sommerfeld Alex, Althouse Andrew D, Prince Jennifer, Atwood Charles W, Mulukutla Suresh R, Hickey Gavin W
Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Department of Internal Medicine, University of Pittsburgh Medical Education Program, Pittsburgh, Pennsylvania.
Clin Cardiol. 2017 Oct;40(10):873-878. doi: 10.1002/clc.22738. Epub 2017 Jun 6.
Heart failure (HF) readmission rates have become an increasingly important quality metric since the advent of the Hospital Readmissions Reduction Program. Despite many well-intentioned efforts to reduce readmissions, clinicians continue to struggle with the problem of high HF readmission rates.
HF patients with obstructive sleep apnea (OSA) will have higher burden of rehospitalization and mortality than HF patients without OSA.
Our study included 344 patient encounters (among 271 unique patients) with a diagnosis of HF from September 2014 through September 2015. Our primary endpoints were all-cause readmission within 30 and 90 days. Multivariate logistic regression was used to assess the relationship between OSA and readmission when accounting for potential confounders.
The patients' were 72 ± 10 years old, and predominantly white (76.2%) and male (99.4%). Among the 344 patient encounters, 247 (71.8%) had diagnosed coronary artery disease, 159 (46.2%) had atrial fibrillation, and 99 (28%) had obstructive sleep apnea (OSA). Notably, patients with OSA had an elevated rate of readmission within 30 days (OSA: 30.3% vs no OSA: 19.6%, P = 0.037) and within 90 days (OSA: 57.6% vs no OSA: 36.3P < 0.01). Patients with OSA had increased risk of readmission within 90 days (odds ratio: 2.38, 95% confidence interval: 1.47-3.83, P < 0.01) even after adjustment for potential confounders of age, race, obesity, diabetes, and chronic obstructive pulmonary disease.
HF patients with OSA have an elevated rate of readmission compared to the general HF population, particularly within the first 90 days after discharge.
自“降低医院再入院率计划”实施以来，心力衰竭（HF）再入院率已成为一项日益重要的质量指标。尽管为降低再入院率付出了诸多善意的努力，但临床医生仍在应对高HF再入院率这一问题。
患有阻塞性睡眠呼吸暂停（OSA）的HF患者比未患OSA的HF患者有更高的再次住院负担和死亡率。
我们的研究纳入了2014年9月至2015年9月期间诊断为HF的344例患者就诊情况（涉及271例不同患者）。我们的主要终点是30天和90天内的全因再入院。在考虑潜在混杂因素时，使用多因素逻辑回归来评估OSA与再入院之间的关系。
患者年龄为72±10岁，主要为白人（76.2%）和男性（99.4%）。在344例患者就诊情况中，247例（71.8%）被诊断患有冠状动脉疾病，159例（46.2%）患有心房颤动，99例（28%）患有阻塞性睡眠呼吸暂停（OSA）。值得注意的是，患有OSA的患者在30天内的再入院率较高（OSA：30.3% vs无OSA：19.6%，P = 0.037），在90天内也是如此（OSA：57.6% vs无OSA：36.3%，P < 0.01）。即使在调整了年龄、种族、肥胖、糖尿病和慢性阻塞性肺疾病等潜在混杂因素后，患有OSA的患者在90天内再次入院的风险仍增加（比值比：2.38，95%置信区间：1.47 - 3.83，P < 0.01）。
与一般HF人群相比，患有OSA的HF患者再入院率较高，尤其是在出院后的前90天内。
