Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.).
Circ Heart Fail. 2018 Apr;11(4):e004634. doi: 10.1161/CIRCHEARTFAILURE.117.004634.
Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality.
The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (<0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; =0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (<0.0001). Both end points demonstrated a dose-response association and statistically significant for trend test.
Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings.
早期活动（EA）与机械通气和中风患者的改善结果相关。对于因急性心力衰竭住院的患者，是否存在相同的关联尚不清楚。我们旨在确定心力衰竭住院患者的 EA 是否与住院时间、出院去向、出院后 30 天再入院和死亡率相关。
该研究人群包括参加 Get With The Guidelines-Heart Failure 注册研究的 369 家医院和 285653 例心力衰竭患者。我们使用医院水平的多变量逻辑回归和广义估计方程来确定 EA 的预测因素，并确定 EA 与结局之间的关联。65%的患者在入院后的第 2 天开始活动。患者层面的 EA 预测因素包括年龄较小、男性和东北部以外的住院治疗（均<0.01）。医院规模和学术地位没有预测作用。医院层面的分析显示，EA 率在前 25%的医院与后 25%的医院相比，住院时间较长（定义为>4 天）的可能性较小（比值比，0.83；95%置信区间，0.73-0.94；=0.004）。在费用报销型医疗保险受益人的亚组中，我们发现 EA 率最高的 quartile 的 30 天再入院率降低了 24%，具有统计学意义（<0.0001）。这两个终点都显示出剂量反应关系和统计学意义的趋势检验。
多变量调整的医院水平分析表明，EA 与较短的住院时间和较低的 30 天再入院率之间存在关联。需要进一步的前瞻性研究来验证这些发现。
