Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON M5G 2N2, Canada.
Institute for Clinical Evaluative Sciences, 2075 Bayview Ave G1 06,Toronto, ON M4N 3M5, Canada.
Eur Heart J Qual Care Clin Outcomes. 2018 Jan 1;4(1):18-26. doi: 10.1093/ehjqcco/qcx015.
Hospitalizations often occur multiple times during the disease course of a heart failure (HF) patient. However, repeated hospitalizations have not been explored in a fulsome way in this setting. We investigated the association between patient factors and the risk of hospitalization among patients with HF using an extension of the Cox model for the analysis of recurrent events.
We examined hospitalizations and predictors of readmission among newly discharged patients with HF in the Enhanced Feedback For Effective Cardiac Treatment phase 1 (April 1999-March 2001) study with the Prentice-Williams-Peterson model with total time. Of 8948 individuals discharged alive from hospital, 7562 (84.5%) were hospitalized at least once during 15-year follow-up. More than 31 000 hospitalizations were observed. There was a progressive shortening of the interval length between hospitalization episodes. An increasing number of comorbidities (average 2.3 per patient) was associated to an increasing hazard of being readmitted to hospital. Most patient factors associated with the risk of hospitalization have been previously described in the literature. However, the estimates were smaller in comparison to a traditional analysis based on the Cox model.
The importance of patient factors for the risk of being admitted to hospital was variable over the course of the disease. Conditions such as diabetes and chronic pulmonary obstructive disease had a sustained association with the rate of hospitalization across all episodes examined. The analysis of recurrent events can explore the longitudinal aspect of HF and the critical issue of hospitalizations in this population.
心力衰竭（HF）患者在疾病过程中经常多次住院。然而，在这种情况下，尚未全面探讨反复住院的情况。我们使用 Cox 模型的扩展来分析复发性事件，研究了患者因素与 HF 患者住院风险之间的关系。
我们在增强反馈有效心脏治疗阶段 1（1999 年 4 月至 2001 年 3 月）研究中，使用 Prentice-Williams-Peterson 模型（总时间）检查了新出院的 HF 患者的住院情况和再入院预测因素。在 15 年的随访中，从医院出院的 8948 人中，有 7562 人（84.5%）至少住院一次。观察到超过 31000 次住院。住院间隔逐渐缩短。合并症的数量增加（平均每位患者 2.3 种）与再次住院的风险增加相关。与住院风险相关的大多数患者因素以前在文献中已有描述。然而，与基于 Cox 模型的传统分析相比，这些估计值较小。
在疾病过程中，患者因素对住院风险的重要性是可变的。在所有检查的发作中，糖尿病和慢性阻塞性肺疾病等疾病与住院率之间存在持续的关联。复发性事件的分析可以探索 HF 的纵向方面和该人群中住院的关键问题。
