Larsson Johan, Kristensen Søren L, Madelaire Christian, Schou Morten, Rossing Kasper, Boesgaard Søren, Køber Lars, Gustafsson Finn
Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.).
Department of Cardiology, Odense University Hospital, Denmark (C.M.).
Circ Heart Fail. 2021 Oct;14(10):e008662. doi: 10.1161/CIRCHEARTFAILURE.121.008662. Epub 2021 Aug 31.
Factors determining referral for advanced heart failure (HF) evaluation are poorly studied. We studied the influence of socioeconomic aspects on the referral process in Denmark, which has a taxpayer-funded national health care system.
We identified all patients aged 18 to 75 years with a first diagnosis of HF during 2010 to 2018. Hospitalized patients had to be discharged alive and were then followed for the outcome of undergoing a right heart catheterization (RHC) used as a surrogate marker of advanced HF work-up.
Of 36 637 newly diagnosed patients with HF, 680 (1.9%) underwent RHC during the follow-up period (median time to RHC of 280 days [interquartile range, 73-914]). Factors associated with a higher likelihood of RHC included the highest versus lowest household income quartile (HR, 1.56 [95% CI, 1.19-2.06]; =0.001), being diagnosed with HF at a tertiary versus nontertiary hospital (HR, 1.68 [95% CI, 1.37-2.05]; <0.001) and during a hospitalization versus outpatient visit (HR, 1.67 [95% CI, 1.42-1.95]; <0.001). Level of education, occupational status, and distance to tertiary hospital were not independently associated with RHC. Older age, cancer, and a psychiatric diagnosis were independently associated with a decreased probability of RHC.
Higher household income, HF diagnosis during hospitalization, and first admission at a tertiary hospital were associated with increased likelihood of subsequent referral for RHC independent of other demographic and clinical variables. Greater attention may be required to ensure timely referral for advanced HF therapies in lower income groups.
关于决定晚期心力衰竭（HF）评估转诊的因素研究较少。我们研究了社会经济因素对丹麦转诊过程的影响，丹麦实行纳税人资助的国家医疗保健系统。
我们确定了2010年至2018年期间首次诊断为HF的所有18至75岁患者。住院患者必须存活出院，然后随访其接受右心导管检查（RHC）的结果，RHC用作晚期HF检查的替代指标。
在36637例新诊断的HF患者中，680例（1.9%）在随访期间接受了RHC（RHC的中位时间为280天[四分位间距，73 - 914]）。与RHC可能性较高相关的因素包括家庭收入最高四分位数与最低四分位数相比（HR，1.56[95%CI，1.19 - 2.06]；P = 0.001）、在三级医院与非三级医院被诊断为HF（HR，1.68[95%CI，1.37 - 2.05]；P < 0.001）以及在住院期间与门诊就诊时被诊断（HR，1.67[95%CI，1.42 - 1.95]；P < 0.001）。教育程度、职业状况和到三级医院的距离与RHC无独立相关性。年龄较大、患有癌症和有精神疾病诊断与RHC可能性降低独立相关。
较高的家庭收入、住院期间的HF诊断以及首次在三级医院就诊与后续转诊进行RHC的可能性增加相关，且独立于其他人口统计学和临床变量。可能需要更加关注以确保低收入群体能及时转诊接受晚期HF治疗。
