Huynh Quan, Venn Alison J, Marwick Thomas H
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Am J Cardiol. 2018 Aug 15;122(4):616-624. doi: 10.1016/j.amjcard.2018.04.051. Epub 2018 Jun 29.
The risk of heart failure (HF) readmission may be reduced by disease management programs, but the resource-intensive nature of these requires targeting to the greatest need. As socioeconomic status (SES) is related to other health outcomes, we sought whether regional markers of SES were associated with days at home (alive and out of hospital) after discharge. This study used statewide data of 1,391 HF patients who had their first ever HF admission to a public hospital in Tasmania (Australia) during 2009 to 2012. Measurements of residential SES included four indexes and a remoteness index generated by the Australian Bureau of Statistics. The primary outcome was days at home. Secondary outcomes included 30- and 90-day readmission or death, number of readmissions, and days to first readmission. Our HF patients had a median of 352 days at home [interquartile range 167, 361]. All four SES indexes and the remoteness index (p <0.001) were adversely associated with days at home, independent of other clinical and nonclinical factors. Findings for readmission at 30 and 90 days of discharge were inconsistent; the index of Relative Socioeconomic Advantage and Disadvantage (but not other SES indexes) was independently associated with 30-day readmission (odds ratio 1.58, p = 0.008) and remoteness index was significantly associated with 90-day readmission (odds ratio = 1.99, p = 0.009). Analyzing days to first readmission did not show any significant differences among categories of SES (log-rank test p = 0.81) or remoteness index (log-rank test p = 0.47). Thus, residential SES is associated with adverse outcome in HF, and might be useful in planning services to reduce HF readmission.
疾病管理项目可能会降低心力衰竭（HF）再入院的风险，但这些项目资源密集，需要针对最迫切的需求。由于社会经济地位（SES）与其他健康结果相关，我们探讨了SES的区域指标是否与出院后在家（存活且未住院）的天数相关。本研究使用了2009年至2012年期间在澳大利亚塔斯马尼亚州一家公立医院首次因HF入院的1391例HF患者的全州数据。居住SES的测量包括澳大利亚统计局生成的四个指数和一个偏远指数。主要结局是在家天数。次要结局包括30天和90天再入院或死亡、再入院次数以及首次再入院天数。我们的HF患者在家天数的中位数为352天[四分位间距167, 361]。所有四个SES指数和偏远指数（p<0.001）均与在家天数呈负相关，且独立于其他临床和非临床因素。出院后30天和90天再入院的结果不一致；相对社会经济优势和劣势指数（而非其他SES指数）与30天再入院独立相关（优势比1.58，p = 0.008），偏远指数与90天再入院显著相关（优势比 = 1.99，p = 0.009）。分析首次再入院天数未显示SES类别（对数秩检验p = 0.81）或偏远指数（对数秩检验p = 0.47）之间存在任何显著差异。因此，居住SES与HF的不良结局相关，可能有助于规划减少HF再入院的服务。
