Martínez Santos Paula, Bover Freire Ramón, Esteban Fernández Alberto, Bernal Sobrino José Luis, Fernández Pérez Cristina, Elola Somoza Francisco Javier, Macaya Miguel Carlos, Vilacosta Isidre
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2019 Dec;72(12):998-1004. doi: 10.1016/j.rec.2019.02.004. Epub 2019 Mar 29.
Heart failure (HF) is a major health care problem in Spain. Epidemiological data from hospitalized patients are scarce and the association between hospital characteristics and patient outcomes is largely unknown. The aim of this study was to identify the factors associated with in-hospital mortality and readmissions and to analyze the relationship between hospital characteristics and outcomes.
A retrospective analysis of discharges with HF as the principal diagnosis at hospitals of the Spanish National Health System in 2012 was performed using the Minimum Basic Data Set. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) and in-hospital mortality at 30 days and 1 year after discharge by using a multivariate mixed model.
We included 77 652 HF patients. Mean age was 79.2±9.9 years and 55.3% were women. In-hospital mortality during the index episode was 9.2%, rising to 14.5% throughout the year of follow-up. The 1-year cardiovascular readmissions rate was 32.6%. RSMR were lower among patients discharged from high-volume hospitals (> 340 HF discharges) (in-hospital RSMR, 10.3±5.6%; 8.6±2.2%); P <.001). High-volume hospitals had higher 1-year RSRR (32.3±3.7%; 33.7±4.5%; P=.006). The availability of a cardiology department at the hospital was associated with better outcomes (in-hospital RSMR, 9.9±3.8%; 9.2±2.4%; P <.001).
High-volume hospitals and the availability of a cardiology department were associated with lower in-hospital mortality.
心力衰竭（HF）是西班牙的一个主要医疗保健问题。来自住院患者的流行病学数据稀缺，医院特征与患者预后之间的关联在很大程度上尚不清楚。本研究的目的是确定与住院死亡率和再入院相关的因素，并分析医院特征与预后之间的关系。
使用最小基本数据集对2012年西班牙国家卫生系统医院中以HF作为主要诊断的出院病例进行回顾性分析。我们通过多变量混合模型计算了索引事件时的风险标准化死亡率（RSMR）、风险标准化心脏病再入院率（RSRR）以及出院后30天和1年的住院死亡率。
我们纳入了77652例HF患者。平均年龄为79.2±9.9岁，55.3%为女性。索引事件期间的住院死亡率为9.2%，在整个随访年度上升至14.5%。1年心血管再入院率为32.6%。高容量医院（>340例HF出院）出院的患者RSMR较低（住院RSMR，10.3±5.6%；8.6±2.2%）；P<.001）。高容量医院的1年RSRR较高（32.3±3.7%；33.7±4.5%；P=.（此处原文有误，应为P = 0.006））。医院设有心脏病科与更好的预后相关（住院RSMR，9.9±3.8%；9.2±2.4%；P<.001）。
高容量医院和设有心脏病科与较低住院死亡率相关。
