Umehara Takuya, Katayama Nobuhisa, Tsunematsu Miwako, Kakehashi Masayuki
Department of Rehabilitation, Saiseikai Kure Hospital, 2-1-13 Sanjo, Kure city, Hiroshima, 737-0821, Japan.
Department of Rehabilitation, Kure Kyosai Hospital, Kure, Japan.
Heart Vessels. 2020 Mar;35(3):367-375. doi: 10.1007/s00380-019-01500-3. Epub 2019 Sep 13.
The purpose of this study was to examine factors influencing readmission to hospital in patients with heart failure. This multicenter, retrospective cohort study analyzed 197 heart failure patients admitted to the research cooperation facilities between January 2017 and November 2017. We defined the readmission group as being readmitted to hospital in ≤ 6 months of discharge and the non-readmission group as > 6 months after discharge. Cox proportional hazards analysis was performed to explore the predictors of readmission. The incidence of readmission was calculated using Kaplan-Meier curves for the extracted factors. Intergroup differences were estimated using the log-rank test. The results of Cox proportional hazards analysis indicated that chronic renal dysfunction (hazard ratio (HR) = 4.729), dementia (HR = 7.105), HFrEF (HR = 8.138), walking without support (HR = 4.031), and walking with a cane (HR = 11.857) significantly contributed to the model. In the survival analyses using the Kaplan-Meier log-rank test, chronic renal dysfunction, dementia, and HFrEF were significant (P < 0.05), but walking without support and walking with a cane after discharge were not significant (P > 0.05). This study suggests that early involvement after discharge is important for lowering the readmission rates in patients with heart failure, even when their walking ability is good.
本研究的目的是探讨影响心力衰竭患者再次入院的因素。这项多中心回顾性队列研究分析了2017年1月至2017年11月期间入住研究合作机构的197例心力衰竭患者。我们将再入院组定义为出院后≤6个月内再次入院的患者,非再入院组定义为出院后>6个月再次入院的患者。进行Cox比例风险分析以探索再入院的预测因素。使用Kaplan-Meier曲线计算提取因素的再入院发生率。使用对数秩检验估计组间差异。Cox比例风险分析结果表明,慢性肾功能不全(风险比(HR)=4.729)、痴呆(HR=7.105)、射血分数降低的心力衰竭(HFrEF,HR=8.138)、无需支撑行走(HR=4.031)和使用拐杖行走(HR=11.857)对模型有显著贡献。在使用Kaplan-Meier对数秩检验的生存分析中,慢性肾功能不全、痴呆和HFrEF具有显著性(P<0.05),但出院后无需支撑行走和使用拐杖行走不具有显著性(P>0.05)。本研究表明,即使心力衰竭患者的行走能力良好,出院后早期干预对于降低其再入院率也很重要。