Jonckers Maren, Van Grootven Bastiaan, Willemyns Ester, Hornikx Miek, Jeuris Anthony, Dubois Christophe, Herregods Marie-Christine, Deschodt Mieke
a Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium.
b Research Foundation Flanders , Flanders , Belgium.
Acta Cardiol. 2018 Jan 4;73(6):566-572. doi: 10.1080/00015385.2017.1421300.
The aim of this study was to determine the incidence and recovery of hospitalisation-associated disability (HAD), the associated risk factors, and the link with care processes in patients aged 70 years or older hospitalised with valvular heart disease (VHD).
Prospective cohort study performed on the cardiology and cardiac surgery units of University Hospitals Leuven, Belgium. HAD was defined as the loss of independence to complete one of the Activities of Daily Living (ADLs) between hospital admission and discharge. Recovery of HAD at 30 days post hospital discharge was achieved when patients recovered their baseline ADL status (2 weeks before hospital admission) (ClinicalTrials.gov: NCT02572999).
Eighty patients were enrolled in the study, 77 completed the assessment at discharge and 62 responded at 30 days follow-up. Forty patients (51.9%) developed HAD; 18 of them (45.0%) recovered their baseline ADL status. The risk of HAD increased when patients were physically restrained (relative risk (RR) 1.73, 95% confidence interval (CI) 1.20-2.49), had indwelling catheters (RR 1.80, 95% CI 0.85-3.80) and received preventive pressure ulcer measures (RR 1.71, 95% CI 1.07-2.74). Patients with HAD had longer hospital stays (+3 days, p = .011) and longer use of indwelling catheters (+2 days, p = .024).
Half of the older adults with VHD developed HAD. The results indicate a potential association between HAD and care processes, which could be used as quality measures and intervention targets. Validation in larger cohort studies is recommended.
本研究旨在确定70岁及以上因瓣膜性心脏病（VHD）住院患者中与住院相关的残疾（HAD）的发生率及恢复情况、相关危险因素以及与护理过程的关联。
在比利时鲁汶大学医院的心脏病学和心脏外科病房进行前瞻性队列研究。HAD被定义为入院至出院期间丧失完成一项日常生活活动（ADL）的独立性。出院后30天，若患者恢复至基线ADL状态（入院前2周），则HAD恢复（ClinicalTrials.gov：NCT02572999）。
80例患者纳入研究，77例在出院时完成评估，62例在30天随访时做出回应。40例患者（51.9%）发生HAD；其中18例（45.0%）恢复至基线ADL状态。当患者受到身体约束时（相对危险度（RR）1.73，95%置信区间（CI）1.20 - 2.49）、留置导尿管时（RR 1.80，95% CI 0.85 - 3.80）以及接受预防压疮措施时（RR 1.71，95% CI 1.07 - 2.74），发生HAD的风险增加。发生HAD的患者住院时间更长（多3天，p = 0.011），留置导尿管的使用时间更长（多2天，p = 0.024）。
一半的老年VHD患者发生HAD。结果表明HAD与护理过程之间存在潜在关联，这可作为质量指标和干预靶点。建议在更大规模的队列研究中进行验证。
