医院容量对住院心力衰竭患者临床结局的影响：基于包括 447818 例心力衰竭患者的全国性数据库的分析。
Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure.
机构信息
The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
出版信息
BMC Cardiovasc Disord. 2021 Jan 25;21(1):49. doi: 10.1186/s12872-021-01863-4.
BACKGROUND
Hospital volume is known to be associated with outcomes of patients requiring complicated medical care. However, the relationship between hospital volume and prognosis of hospitalized patients with heart failure (HF) remains not fully understood. We aimed to clarify the impact of hospital volume on clinical outcomes of hospitalized HF patients using a nationwide inpatient database.
METHODS AND RESULTS
We studied 447,818 hospitalized HF patients who were admitted from January 2010 and discharged until March 2018 included in the Japanese Diagnosis Procedure Combination database. According to the number of patients, patients were categorized into three groups; those treated in low-, medium-, and high-volume centers. The median age was 81 years and 238,192 patients (53%) were men. Patients who had New York Heart Association class IV symptom and requiring inotropic agent within two days were more common in high volume centers than in low volume centers. Respiratory support, hemodialysis, and intra-aortic balloon pumping were more frequently performed in high volume centers. As a result, length of hospital stay was shorter, and in-hospital mortality was lower in high volume centers. Lower in-hospital mortality was associated with higher hospital volume. Multivariable logistic regression analysis fitted with generalized estimating equation indicated that medium-volume group (Odds ratio 0.91, p = 0.035) and high-volume group (Odds ratio 0.86, p = 0.004) had lower in-hospital mortality compared to the low-volume group. Subgroup analysis showed that this association between hospital volume and in-hospital mortality among overall population was seen in all subgroups according to age, presence of chronic renal failure, and New York Heart Association class.
CONCLUSION
Hospital volume was independently associated with ameliorated clinical outcomes of hospitalized patients with HF.
背景
医院的容量与需要复杂医疗护理的患者的治疗结果有关。然而，医院容量与心力衰竭（HF）住院患者的预后之间的关系尚未完全了解。我们旨在使用全国住院患者数据库阐明医院容量对住院 HF 患者临床结果的影响。
方法和结果
我们研究了 2010 年 1 月至 2018 年 3 月期间包括在日本诊断程序组合数据库中的 447818 例因心力衰竭住院的患者。根据患者人数，患者分为三组：低、中、高容量中心治疗的患者。中位年龄为 81 岁，238192 例（53%）为男性。与低容量中心相比，高容量中心中纽约心脏协会（NYHA）IV 级症状和需要在两天内使用正性肌力药物的患者更为常见。高容量中心更频繁地进行呼吸支持、血液透析和主动脉内球囊泵。结果，高容量中心的住院时间更短，院内死亡率更低。较低的院内死亡率与较高的医院容量相关。采用广义估计方程拟合的多变量逻辑回归分析表明，中容量组（优势比 0.91，p=0.035）和高容量组（优势比 0.86，p=0.004）的院内死亡率低于低容量组。亚组分析表明，这种医院容量与全人群中院内死亡率之间的相关性在根据年龄、慢性肾功能衰竭和 NYHA 分级的所有亚组中均可见。
结论
医院容量与心力衰竭住院患者的临床结果改善独立相关。
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