Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA.
Department of Medicine Massachusetts General Hospital Boston MA.
J Am Heart Assoc. 2020 May 18;9(10):e015978. doi: 10.1161/JAHA.119.015978. Epub 2020 May 8.
Background Home-time, defined as the time spent alive outside of a healthcare institution, has emerged as a patient-centered health outcome. The discharge locations and distribution of home-time after a type 2 myocardial infarction are unknown. Methods and Results Patients with a type 2 myocardial infarction between October 2017 and May 2018 at Massachusetts General Hospital were included. Patients discharged to hospice or without follow-up data were excluded. Our primary outcome was home-time defined as the number of days lived outside of a hospital, long-term acute care facility, skilled nursing facility, or rehabilitation facility. We identified 359 patients with type 2 myocardial infarction over the study period. Of those discharged alive (N=321), 62.9% were discharged home, and the remainder went to a facility or hospice. Among those with available follow-up data (N=289), the median home-time was 30 (interquartile range [IQR], 16-30) days at 30 days, 171 (IQR, 133-180) days at 180 days, and 347 (IQR, 203-362) days at 365 days. At 1 year, 29 patients (10%) with type 2 myocardial infarction had spent no time at home and only 57 patients (19.7%) spent the entire year alive and at home. At 1 year, postdischarge all-cause mortality was 23.2%, all-cause readmission was 69.2%, and major adverse cardiovascular events (composite of all-cause mortality, recurrent myocardial infarction, or stroke) was 34.9%. Home-time through 1 year correlated strongly with time-to-event all-cause mortality (τ=0.54, <0.001) and major adverse cardiovascular events (τ=0.52, <0.001) and modestly with a composite of all-cause mortality or readmission (τ=0.44, <0.001). Conclusions Home-time is low after a hospitalization for type 2 myocardial infarction and correlates strongly with mortality and major adverse cardiovascular events.
居家时间，即患者在医疗机构外的存活时间，已成为以患者为中心的健康结果指标。2 型心肌梗死患者出院后的去向和居家时间分布情况尚不清楚。
本研究纳入 2017 年 10 月至 2018 年 5 月期间在马萨诸塞州综合医院接受治疗的 2 型心肌梗死患者。排除接受临终关怀或无随访数据的患者。我们的主要结局指标为居家时间，定义为患者在出院后离开医院、长期急性护理机构、熟练护理机构或康复机构的天数。研究期间共纳入 359 例 2 型心肌梗死患者。其中，321 例存活患者出院，62.9%出院回家，其余患者则去往其他医疗机构或接受临终关怀。在 289 例有随访数据的患者中，30 天、180 天和 365 天的中位数居家时间分别为 30（四分位距[IQR]，16-30）天、171（IQR，133-180）天和 347（IQR，203-362）天。在 1 年时，29 例（10%）2 型心肌梗死患者未在家中度过任何时间，只有 57 例（19.7%）患者在 1 年内一直存活并在家中。1 年后，患者的全因死亡率为 23.2%，全因再入院率为 69.2%，主要不良心血管事件（全因死亡率、再发心肌梗死或卒中等复合终点）发生率为 34.9%。1 年内的居家时间与全因死亡率（τ=0.54，<0.001）和主要不良心血管事件（τ=0.52，<0.001）的时间依赖性事件具有较强相关性，与全因死亡率或再入院率的复合终点（τ=0.44，<0.001）具有中度相关性。
2 型心肌梗死患者住院后居家时间较短，与死亡率和主要不良心血管事件密切相关。
