Ghali J K, Kadakia S, Cooper R, Ferlinz J
Department of Medicine, Cook County Hospital, Chicago, IL 60612.
Arch Intern Med. 1988 Sep;148(9):2013-6.
Potential precipitating factors that led to cardiac decompensation and subsequent hospital admission for heart failure were examined in 101 patients in a large public hospital serving a predominantly working-class minority population. Ninety-seven percent of patients were black; their age was 59 +/- 14 years (mean +/- SD); on average, they were hospitalized three times in the preceding year for problems related to their heart failure. Potential precipitating factors for decompensated heart failure were identified in 93% of patients. Lack of adherence to the prescribed medical regimen was the most commonly identified causative factor and was noted in 64% of the cases; noncompliance with diet amounted to 22%, with drugs to 6%, and with the combination of drugs and diet to 37%. Other factors also related to hospitalization were cardiac arrhythmias (29%), emotional/environmental issues (26%), inadequately conceived drug therapy (17%), pulmonary infections (12%), and thyrotoxicosis (1%). Thus, the key preventive measure necessary in at least two thirds of patients centered around better adherence to drug and/or diet regimen, highlighting the precept that better patient education is mandatory if we are to minimize the number of hospital admissions for decompensated heart failure.
在一家主要服务于工人阶级少数族裔人群的大型公立医院中，对101例患者进行了研究，以探讨导致心脏失代偿及随后因心力衰竭住院的潜在诱发因素。97%的患者为黑人；他们的年龄为59±14岁（均值±标准差）；平均而言，他们在前一年因心力衰竭相关问题住院三次。93%的患者确定了失代偿性心力衰竭的潜在诱发因素。未遵守规定的医疗方案是最常确定的致病因素，64%的病例中存在该情况；不遵守饮食规定的占22%，不遵守药物治疗的占6%，同时不遵守药物和饮食规定的占37%。其他与住院相关的因素包括心律失常（29%）、情绪/环境问题（26%）、药物治疗方案不合理（17%）、肺部感染（12%）和甲状腺毒症（1%）。因此，至少三分之二患者所需的关键预防措施集中在更好地遵守药物和/或饮食方案上，这凸显了一个原则，即如果我们要尽量减少失代偿性心力衰竭的住院人数，更好地对患者进行教育是必不可少的。
