Luk Adriana, Wang Vicki N, Almazroa Loai, Foroutan Farid, Huebener Nikki, Hillyer Alexandra G, Billia Filio, Ross Heather, Overgaard Christopher B
Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
CJC Open. 2020 Mar 4;2(4):229-235. doi: 10.1016/j.cjco.2020.02.010. eCollection 2020 Jul.
Heart failure (HF) is a common reason for admission to the cardiac intensive care unit. We sought to identify the role of an HF consultation service in improving the management of this patient population.
We identified all adult patients admitted to the cardiac intensive care unit (2014-2015) at the University Health Network with a diagnosis of acute decompensated HF ± cardiogenic shock (CS). Clinical characteristics and course were recorded. We calculated a propensity score-adjusted association between HF consultation and in-hospital mortality.
A total of 285 unique patients were identified in our cohort. Of these, 82 (28.7%) died. A total of 150 patients (52.6%) were co-managed by an HF service, and 135 patients (47.3%) were not. Patients who were managed by an HF team were younger (52.5 vs 68.0 years, 0.0001), were more likely to be admitted with CS (61.3 vs 41.5%, 0.0009), and had higher rates of vasoactive medications during their admission (69.3% vs 52.6%, 0.005). At discharge, there were higher rates of discharge to a HF clinic (52.0% vs 27.5%, 0.0001) and prescription of guideline-directed medical therapy. In-hospital mortality was lower in those co-managed by a HF team (16.7% vs 42.2%, 0.0001). HF consultation reduced the odds of readmission by 76% (odds ratio, 0.24; 95% confidence interval, 0.13-0.47).
Patients managed by a HF team were more likely to be in CS at admission, to survive to discharge from hospital, and to be initiated on guideline-directed medical therapy with HF follow-up.
心力衰竭（HF）是入住心脏重症监护病房的常见原因。我们试图确定心力衰竭会诊服务在改善该患者群体管理方面的作用。
我们确定了大学健康网络心脏重症监护病房（2014 - 2015年）收治的所有诊断为急性失代偿性心力衰竭±心源性休克（CS）的成年患者。记录临床特征和病程。我们计算了心力衰竭会诊与住院死亡率之间倾向评分调整后的关联。
我们的队列中总共确定了285例独特患者。其中，82例（28.7%）死亡。共有150例患者（52.6%）由心力衰竭服务团队共同管理，135例患者（47.3%）未接受共同管理。由心力衰竭团队管理的患者更年轻（52.5岁对68.0岁，P = 0.0001），更有可能因心源性休克入院（61.3%对41.5%，P = 0.0009），住院期间使用血管活性药物的比例更高（69.3%对52.6%，P = 0.005）。出院时，转至心力衰竭门诊的比例更高（52.0%对27.5%，P = 0.0001），且接受指南指导药物治疗的处方率更高。由心力衰竭团队共同管理的患者住院死亡率更低（16.7%对42.2%，P = 0.0001）。心力衰竭会诊使再入院几率降低了76%（比值比，0.24；95%置信区间，0.13 - 0.47）。
由心力衰竭团队管理的患者入院时更有可能处于心源性休克状态，更有可能存活至出院，并开始接受指南指导的药物治疗及心力衰竭随访。
