射血分数保留的心力衰竭和 30 天再入院率。
Heart Failure with Preserved Ejection Fraction and 30-Day Readmission.
机构信息
Southern Illinois University School of Medicine, Springfield, Illinois, USA
Southern Illinois University School of Medicine, Springfield, Illinois, USA.
出版信息
Clin Med Res. 2020 Dec;18(4):126-132. doi: 10.3121/cmr.2020.1521. Epub 2020 Apr 27.
OBJECTIVE
Several studies identify heart failure (HF) as a potential risk for hospital readmission; however, studies on predictability of heart failure readmission is limited. The objective of this work was to investigate whether a specific type of heart failure (HFpEF or HFrEF) has a higher association to the rate of 30-day hospital readmission and compare their predictability with the two risk scores: HOSPITAL score and LACE index.
DESIGN
Retrospective study from single academic center.
METHODS
Sample size included adult patients from an academic hospital in a two-year period (2015 - 2017). Exclusion criteria included death, transfer to another hospital, and unadvised leave from hospital. Baseline characteristics, diagnosis-related group, and ICD diagnosis codes were obtained. Variables affecting HOSPITAL score and LACE index and types of heart failure present were also extracted. Qualitative variables were compared using Pearson chi or Fisher's exact test (reported as frequency) and quantitative variables using non-parametric Mann-Whitney U test (reported as mean ± standard deviation). Variables from univariate analysis with values of 0.05 or less were further analyzed using multivariate logistic regression. Odds ratio was used to measure potential risk.
RESULTS
The sample size of adult patients in the study period was 1,916. All eligible cohort of patients who were readmitted were analyzed. Cumulative score indicators of HOSPITAL Score, LACE index (including the Charlson Comorbidity Index) predicted 30-day readmissions with values of <0.001. The value of HFpEF was found to be significant in the readmitted group ( < 0.001) compared to HFrEF ( = 0.141). Multivariate logistic regression further demonstrated the association of HFpEF with higher risk of readmission with odds ratio of 1.77 (95% CI: 1.25 - 2.50) and value of 0.001.
CONCLUSIONS
Our data from an academic tertiary care center supports HFpEF as an independent risk factor for readmission. Multidisciplinary management of HFpEF may be an important target for interventions to reduce hospital readmissions.
目的
多项研究将心力衰竭（HF）确定为医院再入院的潜在风险；然而，心力衰竭再入院预测的研究有限。本研究的目的是探讨特定类型的心力衰竭（HFpEF 或 HFrEF）与 30 天内医院再入院率的相关性，并将其与 HOSPITAL 评分和 LACE 指数这两种风险评分进行比较。
设计
单中心回顾性研究。
方法
样本量包括来自学术医院的两年内（2015-2017 年）的成年患者。排除标准包括死亡、转院和未经医嘱擅自离院。获取了基线特征、诊断相关组和 ICD 诊断代码。还提取了影响 HOSPITAL 评分和 LACE 指数以及存在的心力衰竭类型的变量。使用 Pearson χ² 或 Fisher 确切检验（报告为频率）比较定性变量，使用非参数 Mann-Whitney U 检验（报告为平均值±标准差）比较定量变量。使用单变量分析，对 值小于 0.05 的变量进行多变量逻辑回归分析。使用优势比来衡量潜在风险。
结果
研究期间成年患者的样本量为 1916 例。对所有符合再入院条件的患者进行了分析。HOSPITAL 评分和 LACE 指数（包括 Charlson 合并症指数）的累积评分指标对 30 天内再入院的预测 值均小于 0.001。与 HFrEF（ = 0.141）相比，HFpEF 组再入院患者的 值显著（ < 0.001）。多变量逻辑回归进一步表明，HFpEF 与再入院风险增加相关，其优势比为 1.77（95%可信区间：1.25-2.50）， 值为 0.001。
结论
我们来自学术三级保健中心的数据支持 HFpEF 是再入院的独立危险因素。HFpEF 的多学科管理可能是减少医院再入院的重要干预目标。
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