Department of Medical Information, CHU, University of Montpellier, Montpellier, France.
PhyMedExp, U1046, INSERM, Montpellier, France.
Sci Rep. 2020 Jun 30;10(1):10644. doi: 10.1038/s41598-020-66788-y.
In patients with heart failure, some organizational and modifiable factors could be prognostic factors. We aimed to assess the association between the in-hospital care pathways during hospitalization for acute heart failure and the risk of readmission. This retrospective study included all elderly patients who were hospitalized for acute heart failure at the Universitary Hospital Lariboisière (Paris) during 2013. We collected the wards attended, length of stay, admission and discharge types, diagnostic procedures, and heart failure discharge treatment. The clinical factors were the specific medical conditions, left ventricular ejection fraction, type of heart failure syndrome, sex, smoking status, and age. Consistent groups of in-hospital care pathways were built using an ascending hierarchical clustering method based on a primary components analysis. The association between the groups and the risk of readmission at 1 month and 1 year (for heart failure or for any cause) were measured via a count data model that was adjusted for clinical factors. This study included 223 patients. Associations between the in-hospital care pathway and the 1 year-readmission status were studied in 207 patients. Five consistent groups were defined: 3 described expected in-hospital care pathways in intensive care units, cardiology and gerontology wards, 1 described deceased patients, and 1 described chaotic pathways. The chaotic pathway strongly increased the risk (p = 0.0054) of 1 year readmission for acute heart failure. The chaotic in-hospital care pathway, occurring in specialized wards, was associated with the risk of readmission. This could promote specific quality improvement actions in these wards. Follow-up research projects should aim to describe the processes causing the generation of chaotic pathways and their consequences.
在心力衰竭患者中，一些组织和可改变的因素可能是预后因素。我们旨在评估急性心力衰竭住院期间住院期间的住院护理途径与再入院风险之间的关系。这项回顾性研究包括 2013 年在巴黎 Lariboisière 大学医院因急性心力衰竭住院的所有老年患者。我们收集了就诊病房、住院时间、入院和出院类型、诊断程序以及心力衰竭出院治疗。临床因素是特定的医疗状况、左心室射血分数、心力衰竭综合征类型、性别、吸烟状况和年龄。基于主成分分析，使用升序层次聚类方法构建了一致的住院护理途径组。通过调整临床因素的计数数据模型，测量了组与 1 个月和 1 年（心力衰竭或任何原因）再入院风险之间的关联。这项研究包括 223 名患者。在 207 名患者中研究了住院护理途径与 1 年再入院状态之间的关联。定义了 5 个一致的组：3 个描述了重症监护病房、心脏病学和老年病房的预期住院护理途径，1 个描述了死亡患者，1 个描述了混乱的途径。混乱的途径强烈增加了 1 年急性心力衰竭再入院的风险（p=0.0054）。发生在专科病房的混乱住院护理途径与再入院风险相关。这可以促进这些病房的特定质量改进措施。后续研究项目应旨在描述导致混乱途径产生的过程及其后果。
