Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
Sci Rep. 2020 Dec 3;10(1):21071. doi: 10.1038/s41598-020-78162-z.
Few reports have discussed appropriate strategies for patient referrals to advanced heart failure (HF) centers with available left ventricular assist devices (LVADs). We examined the association between the characteristics and prognoses of referred patients with advanced HF and the bed volume of the referring hospitals. This retrospective analysis evaluated 186 patients with advanced HF referred to our center for consultation about the indication of LVAD between January 1, 2015, and August 31, 2018. We divided the patients into two groups according to the bed volume of their referring hospital (high bed volume hospitals (HBHs): ≥ 500 beds in the hospital; low bed volume hospitals (LBHs): < 500 beds). We compared the primary outcome measure, a composite of LVAD implantation and all-cause death, between the patients referred from HBHs and patients referred from LBHs. The 186 patients with advanced HF referred to our hospital, who were referred from 130 hospitals (87 from LBHs and 99 from HBHs), had a mean age of 43.0 ± 12.6 years and a median left ventricular ejection fraction of 22% [15-33%]. The median follow-up duration of the patients was 583 days (119-965 days), and the primary outcome occurred during follow-up in 42 patients (43%) in the HBH group and 20 patients (23%) in the LBH group. Patients referred from HBHs tended to require catecholamine infusion on transfer more often than those referred from LBLs (36.5% (HBH), 20.2% (LBL), P = 0.021). Kaplan-Meier analysis indicates that the occurrence of the primary outcome was significantly higher in the HBH patients than in the LBH patients (log-rank P = 0.0022). Multivariate Cox proportional hazards analysis revealed that catecholamine support on transfer and long disease duration were statistically significant predictors of the primary outcome. Patients from HBHs had a greater risk of the primary outcome. However, the multivariate analysis did not indicate an association between referral from an HBH and the primary outcome. In contrast, catecholamine support on transfer, long duration of disease, and low blood pressure were independent predictors of the primary outcome. Therefore, these should be considered when determining the timing of a referral to an advanced HF center, irrespective of the bed volume of the referring hospital.
目前，鲜有文献报道对于存在可利用左心室辅助装置（LVAD）的晚期心力衰竭（HF）中心，应如何为患者选择合适的转诊策略。本研究旨在探讨转诊至我院的晚期 HF 患者的特征和预后与转诊医院的床位数之间的关系。本回顾性分析纳入了 2015 年 1 月 1 日至 2018 年 8 月 31 日期间，因 LVAD 适应证问题转诊至我院的 186 例晚期 HF 患者。根据转诊医院的床位数（高床位数医院（HBH）：≥ 500 张床位；低床位数医院（LBH）：＜500 张床位）将患者分为两组。比较两组患者的主要转归指标，即 LVAD 植入和全因死亡的复合终点。本研究共纳入了 186 例从 130 家医院（87 家来自 LBH，99 家来自 HBH）转诊而来的晚期 HF 患者，患者的平均年龄为 43.0±12.6 岁，中位左心室射血分数为 22%[15-33%]。患者的中位随访时间为 583 天（119-965 天），HBH 组中有 42 例（43%）患者和 LBH 组中有 20 例（23%）患者在随访期间发生了主要转归事件。HBH 组中需要在转诊时使用儿茶酚胺输注的患者比例高于 LBH 组（36.5%（HBH）vs. 20.2%（LBH），P=0.021）。Kaplan-Meier 分析表明，HBH 组患者发生主要转归的风险显著高于 LBH 组（log-rank P=0.0022）。多变量 Cox 比例风险分析显示，转诊时使用儿茶酚胺支持和疾病持续时间较长是主要转归的统计学显著预测因素。HBH 组患者发生主要转归的风险更高。然而，多变量分析并未显示 HBH 转诊与主要转归之间存在关联。相比之下，转诊时使用儿茶酚胺支持、疾病持续时间长和低血压是主要转归的独立预测因素。因此，在决定将晚期 HF 患者转诊至 HF 中心时，无论转诊医院的床位数如何，都应考虑这些因素。
