瑞典心力衰竭患者特定病因再入院的时间趋势及其危险因素。
Temporal trends in cause-specific readmissions and their risk factors in heart failure patients in Sweden.
机构信息
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
出版信息
Int J Cardiol. 2020 May 1;306:116-122. doi: 10.1016/j.ijcard.2020.02.048. Epub 2020 Feb 22.
BACKGROUND
It remains unclear whether readmissions of patients with heart failure (HF) have decreased over time in an era of improved therapy and management of HF. This study aimed to determine the temporal short- and long-term trends of cause-specific rehospitalization and their risk factors in a Swedish context.
METHODS
HF patients in the Swedish Heart Failure Registry (SwedeHF) were investigated. Maximum follow-up time was 1 year. Outcomes included the first occurrence of all-cause, cardiovascular (CV) and HF rehospitalizations. Cox proportional hazards models were performed to determine the impact of increasing years on risk for rehospitalization and its known risk factors.
RESULTS
Totally, 25,644 index-hospitalized HF patients in SwedeHF from 2004 to 2011 were enrolled in the study. For 8 years, the incidence risk of 1-year all-cause rehospitalization remained unchanged, whereas the incidence risk of CV (P = 0.038) or HF (P = 0.0038) rehospitalization decreased. After adjustment for age and sex, a 3% decrease per every second year was observed for 1-year CV and HF rehospitalizations (P < 0.05). However, time to the first occurring all-cause, CV and HF rehospitalization did not change significantly from 2004 to 2011 (P-values 0.13-0.87). When two study periods (2004-2005 vs. 2010-2011) were compared, the risk factor profile for rehospitalization was found to change.
CONCLUSIONS
Throughout the 8-year study period, CV- and HF-related rehospitalizations decreased, whereas all-cause rehospitalization remained unchanged, indicating a parallel increase in non-CV rehospitalization in the HF patients.
背景
在心力衰竭（HF）治疗和管理得到改善的时代，HF 患者的再入院率是否随时间的推移而降低仍不清楚。本研究旨在确定在瑞典背景下，特定病因 HF 再入院的短期和长期时间趋势及其危险因素。
方法
对瑞典心力衰竭注册中心（SwedeHF）中的 HF 患者进行了研究。最大随访时间为 1 年。结局包括全因、心血管（CV）和 HF 再入院的首次发生。采用 Cox 比例风险模型确定随着时间的推移对再入院风险及其已知危险因素的影响。
结果
总共纳入了 2004 年至 2011 年 SwedeHF 中 25644 例索引住院 HF 患者。在 8 年的时间里，1 年全因再入院的发生率风险保持不变，而 CV（P=0.038）或 HF（P=0.0038）再入院的发生率风险降低。调整年龄和性别后，观察到每过两年，1 年 CV 和 HF 再入院的发生率分别降低 3%（P<0.05）。然而，从 2004 年到 2011 年，首次发生全因、CV 和 HF 再入院的时间没有明显变化（P 值为 0.13-0.87）。当比较两个研究期（2004-2005 年与 2010-2011 年）时，发现再入院的危险因素谱发生了变化。
结论
在 8 年的研究期间，CV 和 HF 相关的再入院减少，而全因再入院保持不变，表明 HF 患者中非 CV 再入院的比例增加。
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