Windy Alonso, PhD, RN Doctoral Student, The Pennsylvania State University, College of Nursing, Hershey. Judith E. Hupcey, EdD, CRNP, FAAN Associate Dean for Research and Professor, Nursing and Medicine, The Pennsylvania State University, College of Nursing, Hershey. Lisa Kitko, PhD, RN, FAHA, FAAN Associate Professor, The Pennsylvania State University, College of Nursing, University Park. Bunny Pozehl, PhD, APRN-NP, FHFSA, FAHA, FAAN Professor and Dorothy Hodges Olson Endowed Chair, University of Nebraska Medical Center, College of Nursing, Omaha. Kevin Kupzyk, PhD Assistant Professor, University of Nebraska Medical Center, College of Nursing, Omaha.
J Cardiovasc Nurs. 2019 Nov/Dec;34(6):454-464. doi: 10.1097/JCN.0000000000000597.
The number of individuals with advanced heart failure (HF) receiving left ventricular assist devices (LVADs) is growing. Postimplantation LVAD recipients return home to both rural and urban locations. The impact of rural or urban living on postimplantation outcomes has not been adequately explored.
This cohort study examined adverse event-free survival, hospitalization-free survival, and all-cause mortality between rural and urban LVAD recipients in the first 2 years after implantation.
Data from LVAD recipients (N = 141) implanted at a single center in the northeastern United States were analyzed. Recipients of LVAD were designated as rural or urban by county of residence. Adverse events, hospitalizations, and survival time were examined using multivariate Cox proportional hazards models.
Thirty-seven percent of LVAD recipients in the cohort were rural. Two-thirds of all LVAD recipients experienced at least 1 adverse event (96/141, 68.1%). Although more urban recipients experienced adverse events, including death, rural versus urban models of both adverse events and survival were nonsignificant (adverse events: log-rank = 1.18, P = .28; hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.57-1.63; P = .89; survival: log-rank =2.81, P = .09; HR, 0.45; 95% CI, 0.17-1.23; P = .12). Rural LVAD recipients experienced significantly more hospitalizations and shorter hospitalization-free survival (log-rank = 6.67, P = .009). However, the HR for survival was nonsignificant (HR, 1.5; 95% CI, 0.94-2.39; P = .08).
Frequent adverse events and hospitalizations are of ongoing concern for LVAD recipients. More data are necessary to understand why urban LVAD recipients may experience shorter survival time compared with rural counterparts. Hospitalization may serve as a protective factor for rural LVAD recipients.
接受左心室辅助装置（LVAD）的晚期心力衰竭（HF）患者数量正在增加。植入后，LVAD 接受者返回家中，居住在农村和城市地区。农村或城市生活对植入后结果的影响尚未得到充分探讨。
本队列研究旨在探讨植入后 2 年内农村和城市 LVAD 接受者的不良事件无事件生存率、无住院生存率和全因死亡率。
分析了在美国东北部一家单中心植入的 141 例 LVAD 接受者的数据。根据居住地的县，将 LVAD 接受者指定为农村或城市。使用多变量 Cox 比例风险模型检查不良事件、住院和生存时间。
队列中有 37%的 LVAD 接受者来自农村。所有 LVAD 接受者中有三分之二至少经历了一次不良事件（96/141，68.1%）。尽管更多的城市接受者经历了不良事件，包括死亡，但农村与城市的不良事件和生存模型均无统计学意义（不良事件：对数秩=1.18，P=0.28；风险比[HR]，0.96；95%置信区间[CI]，0.57-1.63；P=0.89；生存：对数秩=2.81，P=0.09；HR，0.45；95% CI，0.17-1.23；P=0.12）。农村 LVAD 接受者经历了更多的住院治疗和更短的无住院生存率（对数秩=6.67，P=0.009）。然而，生存的 HR 无统计学意义（HR，1.5；95% CI，0.94-2.39；P=0.08）。
LVAD 接受者经常出现不良事件和住院治疗，这令人持续关注。需要更多的数据来了解为什么城市 LVAD 接受者的生存时间可能比农村接受者短。住院治疗可能是农村 LVAD 接受者的保护因素。
