Akintoye Emmanuel, Briasoulis Alexandros, Egbe Alexander, Adegbala Oluwole, Sheikh Muhammad, Singh Manmohan, Alliu Samson, Ahmed Abdelrahman, Asleh Rabea, Kushwaha Sudhir, Levine Diane
Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Department of Cardiology, Mayo Clinic, Rochester, New York.
Am J Cardiol. 2017 Sep 1;120(5):817-824. doi: 10.1016/j.amjcard.2017.05.058. Epub 2017 Jun 15.
The objective of the study was to provide contemporary evidence on regional variation in hospitalization outcomes in patients with heart failure (HF) in the United States. Using the National Inpatient Sample, we compared hospitalization outcomes among primary HF admissions (2013 to 2014) among the 4 Census regions of the United States. Overall, an estimated 1.9 million HF hospitalizations occurred in the United States over the study period. Mortality rate was 3%, the mean length of stay was 5.3 days, the median cost of hospitalization was US$7,248, and the rate of routine home discharge was 51%. There was a significant regional variation for all end points (p <0.001); for example, compared with other regions of the country, the risk-adjusted rate of in-hospital mortality was highest in the Northeast (3.2%) and lowest in the Midwest (2.7%); and within each region, these mortalities were higher in the rural locations (range: 3.0% to 3.8%) than in the urban locations (range: 2.7% to 3.1%). In addition, the Northeast region had the longest length of stay (mean: 5.9 days) and the lowest risk-adjusted rate of routine home discharge (42%). However, the cost of hospitalization was highest in the West (median: US$8,898) and lowest in the South (US$6,366). A similar pattern of variation was found in subgroup analysis except that the risk-adjusted rate of in-hospital mortality was highest in the West among patients <65 years (1.7% vs 1.2% [lowest] in the Midwest), male gender (3.2% vs 2.8% in the Midwest), and rural location (3.8% vs 3% in the Midwest). In conclusion, HF hospitalization outcomes tend to be worse in the Northeast compared with other regions of the country. In addition, the in-hospital mortality rate was higher in rural locations than in urban locations.
该研究的目的是提供关于美国心力衰竭（HF）患者住院结局区域差异的当代证据。利用全国住院患者样本，我们比较了美国4个人口普查区域原发性HF住院（2013年至2014年）的住院结局。总体而言，在研究期间美国估计有190万例HF住院病例。死亡率为3%，平均住院时间为5.3天，住院费用中位数为7248美元，常规出院回家率为51%。所有终点均存在显著的区域差异（p<0.001）；例如，与该国其他地区相比，东北地区的风险调整后住院死亡率最高（3.2%），中西部地区最低（2.7%）；在每个区域内，农村地区的这些死亡率（范围：3.0%至3.8%）高于城市地区（范围：2.7%至3.1%）。此外，东北地区的住院时间最长（平均：5.9天），风险调整后常规出院回家率最低（42%）。然而，西部地区的住院费用最高（中位数：8898美元），南部地区最低（6366美元）。在亚组分析中发现了类似的差异模式，不同的是在65岁以下患者（西部地区为1.7%，而中西部地区最低为1.2%）、男性（西部地区为3.2%，中西部地区为2.8%）和农村地区（西部地区为3.8% vs中西部地区为3%）中，西部地区的风险调整后住院死亡率最高。总之，与该国其他地区相比，东北地区的HF住院结局往往更差。此外，农村地区的住院死亡率高于城市地区。
