Plakht Ygal, Greenberg Dan, Gilutz Harel, Arbelle Jonathan Eli, Shiyovich Arthur
Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva 8410501, Israel.
J Clin Med. 2020 Aug 5;9(8):2528. doi: 10.3390/jcm9082528.
Healthcare resource utilization peaks throughout the first year following acute myocardial infarction (AMI). Data linking the former and outcomes are sparse. We evaluated the associations between subsequent length of in-hospital stay (SLOS) and primary ambulatory visits (PAV) within the first year after AMI and long-term mortality. This retrospective analysis included patients who were discharged following an AMI. Study groups: low (0-1 days), intermediate (2-7) and high (≥8 days) SLOS; low (<10) and high (≥10 visits) PAV, throughout the first post-AMI year. All-cause mortality was set as the primary outcome. Overall, 8112 patients were included: 55.2%, 23.4% and 21.4% in low, intermediate and high SLOS groups respectively; 26.0% and 74.0% in low and high-PAV groups. Throughout the follow-up period (up to 18 years), 49.6% patients died. Multivariable analysis showed that an increased SLOS (Hazard ratio (HR) = 1.313 and HR = 1.714 for intermediate and high vs. low groups respectively) and a reduced number of PAV (HR = 1.24 for low vs. high groups) were independently associated with an increased risk for mortality ( < 0.001 for each). Long-term mortality following AMI is associated with high hospital and low primary ambulatory services utilization throughout the first-year post-discharge. Measures focusing on patients with increased SLOS and reduced PAV should be considered to improve patient outcomes.
在急性心肌梗死（AMI）后的第一年，医疗资源利用率达到峰值。将前者与预后相关联的数据很少。我们评估了AMI后第一年住院时间（SLOS）和初级门诊就诊次数（PAV）与长期死亡率之间的关联。这项回顾性分析纳入了AMI后出院的患者。研究分组：SLOS低（0 - 1天）、中（2 - 7天）和高（≥8天）；AMI后第一年PAV低（<10次）和高（≥10次）。全因死亡率作为主要结局。总体而言，纳入了8112例患者：SLOS低、中、高组分别占55.2%、23.4%和21.4%；PAV低和高组分别占26.0%和74.0%。在整个随访期（长达18年），49.6%的患者死亡。多变量分析显示，SLOS增加（中、高组与低组相比，风险比（HR）分别为1.313和1.714）以及PAV次数减少（低组与高组相比，HR = 1.24）与死亡风险增加独立相关（每组P < 0.001）。AMI后的长期死亡率与出院后第一年高住院率和低初级门诊服务利用率相关。应考虑针对SLOS增加和PAV减少的患者采取措施以改善患者预后。
