Women's College Research Institute, Toronto, Canada.
Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.
BMC Cardiovasc Disord. 2020 May 14;20(1):223. doi: 10.1186/s12872-020-01422-3.
BACKGROUND: Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender. METHODS: We conducted a scoping review using the Arksey and O'Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis. RESULTS: The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/abstract; 88% full text; kappa: 0.69 (95%CI: 0.53-0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year. CONCLUSIONS: Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Co-interventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.
背景：心力衰竭（HF）患者的院内再入院问题不仅存在于男性中，也存在于女性中，但关于不同性别再入院率的差异，人们知之甚少。因此，仍不清楚如何优化女性和男性的再入院率降低计划和护理策略。本研究的目的是：（1）确定根据性别研究再入院率的研究；（2）提供关于性别影响的可能考虑因素的定性概述。
方法：我们采用 Arksey 和 O'Malley 框架进行了范围综述，纳入了 2002 年至 2017 年期间发表的来自多个数据库（MEDLINE、EMBASE）、灰色文献（即国家技术信息、Duck Duck Go）和专家咨询的全文文章。符合条件的文章包括索引心力衰竭发作、再入院率和基于性别的分析。
结果：搜索产生了 5887 篇文章，其中 746 篇进行了全文摘要考虑是否符合条件。在 164 篇符合条件的文章中，34 篇文章主要研究结果，103 篇文章次要研究结果为性别差异，25 篇文章对性别数据进行分层。研究人员之间的一致性非常好：83%的标题/摘要；88%的全文；kappa 值：0.69（95%置信区间：0.53-0.85）。34 篇研究中有 12 篇报告男性心力衰竭再入院率较高，6 篇报告女性心力衰竭再入院率较高。使用非综合终点，5 篇研究报告男性心力衰竭再入院率较高，3 篇研究报告女性心力衰竭再入院率较高。总体而言，按性别检查时，研究之间存在异质性，但有一个观察结果与再入院时间有关。当随访时间超过 1 年时，男性的再入院率更高。当时间到事件小于 1 年时，女性的再入院率比男性更高。
结论：未来的研究应在设计中考虑不同的时间范围，并避免使用复合指标，如再入院率与死亡率相结合的指标，这些指标受性别影响极大。联合干预和针对出院后的针对性方法，关注性别差异，将有益于心力衰竭患者群体。
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