Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS.
Med J Aust. 2018 Jun 18;208(11):485-491. doi: 10.5694/mja17.00809. Epub 2018 May 14.
To investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes.
Cohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF.
All-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission.
58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings.
Differences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.
探讨心力衰竭（HF）患者出院后参加管理项目是否降低了出院后不良结局的可能性。
在这项队列研究中，评估了住院治疗 HF 的患者在 30 天和 90 天的不良结局与基线临床、社会人口统计学和血液病理学因素以及与出院后管理策略之间的关系。
地点、参与者：前瞻性纳入了来自澳大利亚五个州的 906 名 HF 患者，这些患者均在心脏病学部门就诊，这些部门拥有治疗 HF 患者的专业知识。
出院后 30 天和 90 天的全因再入院和死亡。
58%的患者为男性，平均年龄为 72.5 岁（标准差为 13.9 岁）。按医院划分，30 天再入院率为 17%至 33%，90 天再入院率为 40%至 55%；30 天死亡率为 0%至 13%，90 天死亡率为 4%至 24%。与 30 天或 90 天再入院或死亡风险增加相关的因素包括独居、认知障碍、抑郁、NYHA 分级、左心房容积指数和 Charlson 指数评分。护士主导的疾病管理项目和 7 天内的检查与 30 天和 90 天的再入院风险降低相关（但与死亡率无关）；运动项目与 90 天的再入院风险降低相关。调整出院后管理方案后，医院间再入院率的差异显著缩小，进一步调整心脏超声检查结果后差异消失。医院间死亡率的差异主要由心脏超声检查结果的差异解释。
HF 患者出院后早期再入院率的差异主要由出院后管理的差异解释。
