PACT-HF随机试验的性别特异性临床结果。
Sex-Specific Clinical Outcomes of the PACT-HF Randomized Trial.
作者信息
Van Spall Harriette G C, DeFilippis Ersilia M, Lee Shun Fu, Oz Urun Erbas, Perez Richard, Healey Jeff S, Allen Larry A, Voors Adriaan A, Ko Dennis T, Thabane Lehana, Connolly Stuart J
机构信息
Department of Medicine (H.G.C.V., J.S.H.), McMasterUniversity, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact (H.G.C.V., S.F.L., J.S.H., L.T., S.J.C.), McMasterUniversity, Hamilton, Ontario, Canada.
出版信息
Circ Heart Fail. 2021 Nov;14(11):e008548. doi: 10.1161/CIRCHEARTFAILURE.121.008548. Epub 2021 Oct 29.
BACKGROUND
Transitional care may have different effects in males and females hospitalized for heart failure. We assessed the sex-specific effects of a transitional care model on clinical outcomes following hospitalization for heart failure.
METHODS
In this stepped-wedge cluster randomized trial of adults hospitalized for heart failure in Ontario, Canada, 10 hospitals were randomized to a group of transitional care services or usual care. Outcomes in this exploratory analysis were composite all-cause readmission, emergency department visit, or death at 6 months; and composite all-cause readmission or emergency department visit at 6 months. Models were adjusted for stepped-wedge design and patient age.
RESULTS
Among 2494 adults, mean (SD) age was 77.7 (12.1) years, and 1258 (50.4%) were female. The first composite outcome occurred in 371 (66.3%) versus 433 (64.1%) males (hazard ratio [HR], 1.04 [95% CI, 0.86-1.26]; =0.67) and in 326 (59.9%) versus 463 (64.8%) females (HR, 0.83 [95% CI, 0.69-1.01]; =0.06) in the intervention and usual care groups, respectively (=0.012 for sex interaction). The second composite outcome occurred in 357 (63.8%) versus 417 (61.7%) males (HR, 1.03 [95% CI, 0.85-1.24]; =0.76) and 314 (57.7%) versus 450 (63.0%) females (HR, 0.81 [95% CI, 0.67-0.99]; =0.037) in the intervention and usual care groups, respectively (=0.024 for sex interaction). The sex differences were driven by a reduction in all-cause emergency department visits among females (HR, 0.66 [95% CI, 0.51-0.87]; =0.003), but not males (HR, 1.10 [95% CI, 0.85-1.43]; =0.46), receiving the intervention (<0.001 for sex interaction).
CONCLUSIONS
A transitional care model offered a reduction in all-cause emergency department visits among females but not males following hospitalization for heart failure. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02112227.
背景
过渡性护理对于因心力衰竭住院的男性和女性可能有不同影响。我们评估了一种过渡性护理模式对心力衰竭住院后临床结局的性别特异性影响。
方法
在加拿大安大略省针对因心力衰竭住院的成年人开展的这项阶梯楔形整群随机试验中，10家医院被随机分为接受过渡性护理服务组或常规护理组。这项探索性分析的结局为6个月时的全因再入院、急诊就诊或死亡的复合结局；以及6个月时的全因再入院或急诊就诊的复合结局。模型针对阶梯楔形设计和患者年龄进行了调整。
结果
在2494名成年人中，平均（标准差）年龄为77.7（12.1）岁，1258名（50.4%）为女性。干预组和常规护理组中，第一个复合结局在男性中的发生率分别为371例（66.3%）和433例（64.1%）（风险比[HR]，1.04[95%CI，0.86 - 1.26]；P = 0.67），在女性中的发生率分别为326例（59.9%）和463例（64.8%）（HR，0.83[95%CI，0.69 - 1.01]；P = 0.06）（性别交互作用P = 0.012）。第二个复合结局在男性中的发生率分别为357例（63.8%）和417例（61.7%）（HR，1.03[95%CI，0.85 - 1.24]；P = 0.76），在女性中的发生率分别为314例（57.7%）和450例（63.0%）（HR，0.81[95%CI，0.67 - 0.99]；P = 0.037）（性别交互作用P = 0.024）。性别差异是由接受干预的女性全因急诊就诊减少（HR，0.66[95%CI，0.51 - 0.87]；P = 0.003）驱动的，而男性并非如此（HR，1.10[95%CI，0.85 - 1.43]；P = 0.46）（性别交互作用P < 0.001）。
结论
一种过渡性护理模式可降低心力衰竭住院后女性的全因急诊就诊率，但对男性无此作用。注册信息：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02112227。
Zotero 插件