住院后早期使用远程介电传感以减少心力衰竭再入院率。
Early use of remote dielectric sensing after hospitalization to reduce heart failure readmissions.
作者信息
Lala Anuradha, Barghash Maya H, Giustino Gennaro, Alvarez-Garcia Jesus, Konje Swiri, Parikh Aditya, Ullman Jennifer, Keith Brendan, Donehey John, Mitter Sumeet S, Trivieri Maria Giovanna, Contreras Johanna P, Burkhoff Daniel, Moss Noah, Mancini Donna M, Pinney Sean P
机构信息
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, PO Box 1030, New York, NY, 10129, USA.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, PO Box 1030, New York, NY, 10129, USA.
出版信息
ESC Heart Fail. 2021 Apr;8(2):1047-1054. doi: 10.1002/ehf2.13026. Epub 2020 Dec 18.
AIMS
Readmission after hospitalization for acute decompensated heart failure (HF) remains a major public health problem. Use of remote dielectric sensing (ReDS) to measure lung water volume allows for an objective assessment of volume status and may guide medical optimization for HF. We hypothesized that the use of ReDS would lower 30 day readmission in patients referred to rapid follow-up (RFU) clinic after HF discharge.
METHODS AND RESULTS
We conducted a retrospective analysis of the use of ReDS for patients scheduled for RFU within 10 days post-discharge for HF at Mount Sinai Hospital between 1 July 2017 and 31 July 2018. Diuretics were adjusted using a pre-specified algorithm. The association between use of ReDS and 30 day readmission was evaluated. A total of 220 patients were included. Mean age was 62.9 ± 14.7 years, and 36.4% were female. ReDS was performed in 80 (36.4%) and led to medication adjustment in 52 (65%). Use of ReDS was associated with a lower rate of 30 day cardiovascular readmission [2.6% vs. 11.8%, hazard ratio (HR): 0.21; 95% confidence interval (CI): 0.05-0.89; P = 0.04] and a trend towards lower all-cause readmission (6.5% vs. 14.1%, HR: 0.43; 95% CI: 0.16-1.15; P = 0.09) as compared with patients without a ReDS assessment.
CONCLUSIONS
ReDS-guided HF therapy during RFU after HF hospitalization may be associated with lower risk of 30 day readmission.
目的
急性失代偿性心力衰竭（HF）住院后的再入院仍然是一个主要的公共卫生问题。使用远程介电传感（ReDS）测量肺水量可对容量状态进行客观评估，并可能指导HF的药物优化治疗。我们假设，在HF出院后转诊至快速随访（RFU）诊所的患者中，使用ReDS可降低30天再入院率。
方法和结果
我们对2017年7月1日至2018年7月31日在西奈山医院出院后10天内计划进行RFU的患者使用ReDS的情况进行了回顾性分析。使用预先指定的算法调整利尿剂。评估了ReDS的使用与30天再入院之间的关联。共纳入220例患者。平均年龄为62.9±14.7岁，女性占36.4%。80例（36.4%）患者进行了ReDS检查，其中52例（65%）患者的治疗药物得到了调整。与未进行ReDS评估的患者相比，使用ReDS与较低的30天心血管再入院率相关[2.6%对11.8%，风险比（HR）：0.21；95%置信区间（CI）：0.05-0.89；P=0.04]，且全因再入院率有降低趋势（6.5%对14.1%，HR：0.43；95%CI：0.16-1.15；P=0.09）。
结论
HF住院后RFU期间，ReDS指导的HF治疗可能与较低的30天再入院风险相关。
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