对于射血分数降低或保留的心力衰竭患者(来自社区动脉粥样硬化风险研究)的反复急性失代偿心力衰竭入院。
Recurrent Acute Decompensated Heart Failure Admissions for Patients With Reduced Versus Preserved Ejection Fraction (from the Atherosclerosis Risk in Communities Study).
机构信息
Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
出版信息
Am J Cardiol. 2018 Jul 1;122(1):108-114. doi: 10.1016/j.amjcard.2018.03.011. Epub 2018 Mar 28.
Hospitals are required to report all-cause 30-day readmissions for patients discharged with heart failure. Same-cause readmissions have received less attention but may differ for heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF). The ARIC study began abstracting medical records for cohort members hospitalized with acute decompensated heart failure (ADHF) in 2005. ADHF was validated by physician review, with HFrEF defined by ejection fraction <50%. Recurrent admissions for ADHF were analyzed within 30 days, 90 days, 6 months, and 1 year of the index hospitalization using repeat-measures Cox regression models. All recurrent ADHF admissions per patient were counted rather than the more typical analysis of only the first occurring readmission. From 2005 to 2014, 1,133 cohort members survived at least 1 hospitalization for ADHF and had ejection fraction recorded. Half were classified as HFpEF. Patients with HFpEF were more often women and had more co-morbidities. The overall ADHF readmission rate was greatest within 30 days of discharge but was higher for patients with HFrEF (115 vs 88 readmissions per 100 person-years). After adjustments for demographics, year of admission, and co-morbidities, there was a trend for higher ADHF readmissions with HFrEF, relative to HFpEF, at 30 days (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.92 to 2.18), 90 days (HR 1.39, 95% CI 1.05 to 1.85), 6 months (HR 1.47, 95% CI, 1.18 to 1.84), and 1 year (HR 1.42, 95% CI 1.18 to 1.70) of follow-up. In conclusion, patients with HFrEF have a greater burden of short- and long-term readmissions for recurrent ADHF.
医院需要报告所有因心力衰竭出院的患者的 30 天再入院率。同样原因的再入院率受到的关注较少,但对于射血分数降低的心力衰竭(HFrEF)与射血分数保留的心力衰竭(HFpEF)可能有所不同。ARIC 研究于 2005 年开始为因急性失代偿性心力衰竭(ADHF)住院的队列成员提取病历。ADHF 通过医生审查进行验证,射血分数<50%定义为 HFrEF。使用重复测量 Cox 回归模型,在指数住院后 30 天、90 天、6 个月和 1 年内分析 ADHF 的复发性入院。每位患者的所有复发性 ADHF 入院均被计算在内,而不仅仅是分析首次发生的再入院。从 2005 年到 2014 年,至少有 1 次因 ADHF 住院且射血分数记录的 1133 名队列成员存活。其中一半被归类为 HFpEF。HFpEF 患者中女性更为常见,且合并症更多。出院后 30 天内 ADHF 的再入院率最高,但 HFrEF 患者的再入院率更高(每 100 人年 115 次与 88 次再入院)。在调整人口统计学因素、入院年份和合并症后,与 HFpEF 相比,HFrEF 在 30 天(危险比 [HR] 1.41,95%置信区间 [CI] 0.92 至 2.18)、90 天(HR 1.39,95%CI 1.05 至 1.85)、6 个月(HR 1.47,95%CI 1.18 至 1.84)和 1 年(HR 1.42,95%CI 1.18 至 1.70)的随访中,ADHF 再入院的趋势更高。总之,HFrEF 患者因复发性 ADHF 的短期和长期再入院负担更大。
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