Wideqvist Maria, Cui Xiaotong, Magnusson Charlotte, Schaufelberger Maria, Fu Michael
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of cardiology Zhongshan Hospital, Fudan University, Shanghai, China.
ESC Heart Fail. 2021 Apr;8(2):1388-1397. doi: 10.1002/ehf2.13221. Epub 2021 Feb 17.
This study aims to investigate hospital readmissions and timing, as well as risk factors in a real world heart failure (HF) population.
All patients discharged alive in 2016 from Sahlgrenska University Hospital/Östra, Gothenburg, Sweden, with a primary diagnosis of HF were consecutively included. Patient characteristics, type of HF, treatment, and follow-up were registered. Time to first all-cause or HF readmission, as well as number of 1 year readmissions from discharge were recorded. In total, 448 patients were included: 273 patients (mean age 78 ± 11.8 years) were readmitted for any cause within 1 year (readmission rate of 60.9%), and 175 patients (mean age 76.6 ± 13.7) were never readmitted. Among readmissions, 60.1% occurred during the first quarter after index hospitalization, giving a 3 month all-cause readmission rate of 36.6%. HF-related 1 year readmission rate was 38.4%. Patients who were readmitted had significantly more renal dysfunction (52.4% vs. 36.6%, P = 0.001), pulmonary disease (25.6% vs. 15.4%, P = 0.010), and psychiatric illness (24.9% vs. 12.0%, P = 0.001). Number of co-morbidities and readmissions were significantly associated (P < 0.001 for all cause readmission rate and P = 0.012 for 1 year HF readmission rate). Worsening HF constituted 63% of all-cause readmissions. Psychiatric disease was an independent risk factor for 1 month and 1 year all-cause readmissions. Poor compliance to medication was an independent risk factor for 1 month and 1 year HF readmission.
In our real world cohort of HF patients, frequent hospital readmissions occurred in the early post-discharge period and were mainly driven by worsening HF. Co-morbidity was one of the most important factors for readmission.
本研究旨在调查实际心力衰竭（HF）患者群体中的再入院情况、时间以及风险因素。
连续纳入2016年从瑞典哥德堡萨尔格伦斯卡大学医院/东院区存活出院且初步诊断为HF的所有患者。记录患者特征、HF类型、治疗情况及随访情况。记录首次全因或HF再入院时间以及出院后1年的再入院次数。总共纳入448例患者：273例患者（平均年龄78±11.8岁）在1年内因任何原因再次入院（再入院率为60.9%），175例患者（平均年龄76.6±13.7岁）从未再次入院。在再入院患者中，60.1%发生在首次住院后的第一季度，3个月全因再入院率为36.6%。HF相关的1年再入院率为38.4%。再次入院的患者肾功能不全（52.4%对36.6%，P = 0.001）、肺部疾病（25.6%对15.4%，P = 0.010）和精神疾病（24.9%对12.0%，P = 0.001）显著更多。合并症数量与再入院次数显著相关（全因再入院率P < 0.001，1年HF再入院率P = 0.012）。HF病情恶化占全因再入院的63%。精神疾病是1个月和1年全因再入院的独立风险因素。药物治疗依从性差是1个月和1年HF再入院的独立风险因素。
在我们的实际HF患者队列中，出院后早期频繁发生医院再入院，主要由HF病情恶化所致。合并症是再入院最重要的因素之一。
