Jørgensen Mette, Mainz Jan, Egstrup Kenneth, Johnsen Søren P
Aalborg University Hospital, Psychiatry, Aalborg, Denmark.
Aalborg University Hospital, Psychiatry, Aalborg, Denmark.
Am J Cardiol. 2017 Sep 15;120(6):980-985. doi: 10.1016/j.amjcard.2017.06.027. Epub 2017 Jun 27.
Research on the association between schizophrenia and the quality of care and clinical outcomes of heart failure (HF) remains sparse. This nationwide study compared the quality of care and clinical outcomes of HF among Danish patients with and without schizophrenia. In a population-based cohort study, we identified 36,718 patients with incident HF with hospital contacts, including 108 with schizophrenia, using Danish registries between 2004 and 2013. High quality of HF care was defined as receiving ≥ 80% guideline-recommended process-performance measures of care. Potential predictors of HF care among patients with schizophrenia included patient-specific factors (age, gender, Global Assessment of Functioning [GAF] score, alcohol or drug abuse, duration of schizophrenia); provider-specific factors (quality of schizophrenia care); and system-specific factors (patient-volume defined as hospital departments and clinics yearly average patient-volume of patients with incident HF). Clinical outcomes included 4-week all-cause readmission and 1-year all-cause mortality after a first-time hospital contact with incident HF. Results showed that compared with patients with incident HF who have no schizophrenia, patients with incident HF who have schizophrenia had a lower chance of receiving high-quality HF care (relative risk 0.66, 95% confidence interval 0.48 to 0.91). A high GAF score was associated with a higher chance of receiving high-quality HF care among patients with incident HF who have schizophrenia. Patients with incident HF who have schizophrenia had a higher risk of 1-year mortality (adjusted hazard ratio 2.83, 95% confidence interval 1.59 to 5.04), but not a higher risk of readmission than patients with incident HF who have no schizophrenia. In conclusion, efforts are warranted to reduce the high mortality among patients with incident HF who have schizophrenia.
关于精神分裂症与心力衰竭（HF）的护理质量及临床结局之间关联的研究仍然较少。这项全国性研究比较了丹麦有和没有精神分裂症的HF患者的护理质量及临床结局。在一项基于人群的队列研究中，我们利用丹麦登记处的数据，在2004年至2013年期间识别出36718例有住院记录的新发HF患者，其中包括108例患有精神分裂症的患者。HF优质护理被定义为接受≥80%指南推荐的护理过程绩效指标。精神分裂症患者HF护理的潜在预测因素包括患者特定因素（年龄、性别、功能总体评估[GAF]评分、酒精或药物滥用、精神分裂症病程）；提供者特定因素（精神分裂症护理质量）；以及系统特定因素（患者数量，定义为医院科室和诊所每年新发HF患者的平均患者数量）。临床结局包括首次因新发HF住院接触后的4周全因再入院率和1年全因死亡率。结果显示，与没有精神分裂症的新发HF患者相比，患有精神分裂症的新发HF患者接受优质HF护理的机会更低（相对风险0.66，95%置信区间0.48至0.91）。高GAF评分与患有精神分裂症的新发HF患者接受优质HF护理的较高机会相关。患有精神分裂症的新发HF患者的1年死亡率风险更高（调整后风险比2.83，95%置信区间1.59至5.04），但与没有精神分裂症的新发HF患者相比，再入院风险并未更高。总之，有必要努力降低患有精神分裂症的新发HF患者的高死亡率。
