Plant Luke D, Taylor David McDonald, Worland Thomas, Puri Arvind, Ugoni Antony, Patel Sheila K, Johnson Douglas F, Burrell Louise M
Department of Emergency Medicine, Austin Hospital, Melbourne, Vic, Australia.
Department of Emergency Medicine, Austin Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
Heart Lung Circ. 2019 Mar;28(3):406-413. doi: 10.1016/j.hlc.2017.12.004. Epub 2017 Dec 23.
We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay.
We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February-May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF.
The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%). Three variables were associated with ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2-9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2-9.1), and the administration of >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5-48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p<0.001) and mortality (12.5% versus 1.3%, p=0.01).
New onset ADHF is common and a substantial proportion of cases are iatrogenic. Cases experience significantly increased length of hospital stay, morbidity, and mortality.
我们旨在调查住院期间发生的急性失代偿性心力衰竭（ADHF）的发病率、诱发因素及预后情况。
我们在一家三级转诊医院的内科、肿瘤科、外科和骨科病房进行了一项病例对照研究（2016年2月至5月）。将住院期间发生ADHF的年龄≥18岁的患者纳入病例组。按照年龄、性别、主诉/所做的手术以及合并症为每个病例匹配一名对照患者。采用多变量回归分析来确定与ADHF相关的变量。
ADHF的发病率为患者总数的1.0%。80例病例与80例对照匹配良好（p>0.05）。ADHF的诱发因素包括感染（30%）、不适当的静脉输液和药物管理（分别为23.8%和8.8%）、快速性心律失常（12.5%）、缺血性心脏病（8.8%）、肾衰竭（1.3%）以及其他/不明原因（15%）。有三个变量与ADHF相关：不以英语为首选语言（比值比3.5，95%置信区间1.2 - 9.8）、有缺血性心脏病史（比值比3.3，95%置信区间1.2 - 9.1）以及在ADHF发生前一天静脉输液量>2000ml（比值比8.3，95%置信区间1.5 - 48.0）。在ADHF发生前一天，病例组的静脉输液量显著多于对照组（中位数2757.5ml对975ml，p = 0.001）。用药错误大多与未能重新开始常规利尿剂治疗有关。病例组的住院时间显著更长（中位数15天对6天，p<0.001）且死亡率更高（12.5%对1.3%，p = 0.01）。
新发ADHF很常见，且相当一部分病例是医源性的。病例的住院时间、发病率和死亡率显著增加。
