Kheirbek Raya Elfadel, Alemi Yara, Wojtusiak Janusz, Kheirbek Lena, Madison Sorina, Fokar Ali, Doukky Rami, Moore Hans J
1 Department of Medicine, Washington DC Veterans Affairs Medical Center, Washington, DC, USA.
2 Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Am J Hosp Palliat Care. 2019 Jul;36(7):623-629. doi: 10.1177/1049909119828712. Epub 2019 Feb 17.
Acute decompensated heart failure (HF) is the leading cause for hospital readmission. Large-scale sustainable interventions to reduce readmission rate have not been fully explored or proven effective.
We studied the impact of hospice and palliative care service utilization on 30-day all-cause hospital readmissions for patients with HF.
Data were retrieved from the Department of Veterans Affairs Corporate Data Warehouse. The study included 238 116 HF admissions with primary diagnosis of HF belonging to 130 812 patients. Among these patients, 2592 had hospice and palliative care utilizations and 68 245 patients did not. Rehospitalization was calculated within 30 days of index hospitalization. Propensity scores were used to match hospice and nonhospice patients on demographics, Charlson comorbidity categories, and 30-day survival. In the matched group, logistic regression was used to estimate effects of hospice on readmission, controlling for any covariates that had failed to balance. The average age of the matched patients was 74 years old, 14% were African American, 75% Caucasian, 2% Asian, and 17% female. After propensity matching, the odds ratio for readmission was 1.29. The 95% confidence interval for the odds was 1.13 to 1.48, suggesting that veterans receiving services have a higher chance of readmission.
In a large cohort study of older US Veterans, utilization of hospice and palliative care services was associated with a higher 30-day all-cause readmission rate among hospitalized patients with HF. Further prospective studies should be conducted to confirm results and test generalizability outside the Veterans Affairs system of care.
急性失代偿性心力衰竭（HF）是医院再入院的主要原因。尚未充分探索或证实大规模可持续干预措施以降低再入院率的有效性。
我们研究了临终关怀和姑息治疗服务的使用对HF患者30天全因医院再入院的影响。
数据取自退伍军人事务部企业数据仓库。该研究纳入了238116例以HF为主要诊断的HF入院病例，涉及130812名患者。在这些患者中，2592例使用了临终关怀和姑息治疗服务，68245例未使用。在首次住院的30天内计算再住院率。倾向评分用于在人口统计学、Charlson合并症类别和30天生存率方面匹配临终关怀患者和非临终关怀患者。在匹配组中，使用逻辑回归估计临终关怀对再入院的影响，控制任何未能平衡的协变量。匹配患者的平均年龄为74岁，14%为非裔美国人，75%为白种人，2%为亚洲人，17%为女性。倾向匹配后，再入院的比值比为1.29。该比值的95%置信区间为1.13至1.48，表明接受服务的退伍军人再入院的可能性更高。
在一项针对美国老年退伍军人的大型队列研究中，临终关怀和姑息治疗服务的使用与HF住院患者较高的30天全因再入院率相关。应进行进一步的前瞻性研究以证实结果并测试在退伍军人事务医疗系统之外的可推广性。
