Department of Cardiology, Austin Health, Melbourne, Vic, Australia.
Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2022 Apr;31(4):491-498. doi: 10.1016/j.hlc.2021.08.020. Epub 2021 Nov 2.
Acute decompensated heart failure (ADHF) is the most common cause of hospital admission in patients over 65, with poorer outcomes demonstrated in rural versus metropolitan areas. The aim of this study was to compare the in-hospital and post-discharge management of ADHF patients admitted to rural versus metropolitan hospitals in Victoria.
Data from the Victorian Cardiac Outcomes Registry, Heart Failure (VCOR-HF) project was used. This was a prospective, observational, non-randomised study of consecutive patients admitted to participating hospitals in Victoria, Australia, with ADHF as their primary diagnosis over four 30-day periods during consecutive years. All patients were followed up for 30 days post discharge.
1,357 patients (1,260 metropolitan, 97 rural) were admitted to study hospitals with ADHF during the study periods. Cohorts were similar in age (average 76.87±13.12 yrs) and percentage of male gender (56.4% overall). Metropolitan patients were more likely to have diabetes (44.4% vs 34.0%, p=0.046), kidney disease (65.8% vs 37.1%, p<0.01) and anaemia (31.9% vs 19.6%, p=0.01). There was no significant difference in length of stay between metropolitan and rural patients (7.49 vs 6.37 days, p=0.12). There was no significant difference between metropolitan and rural patients in 30-day rehospitalisations (19.1% vs 11.6%, p=0.07, respectively) and all-cause 30-day mortality (8.2% vs 4.1%, p=0.15, respectively). Metropolitan patients were significantly more likely to have seen their general practitioner (GP) (68.1% vs 53.2%, p<0.01) or attend an outpatient clinic (35.9% vs 10.6%, p<0.01) by 30 days. There was no significant difference in number of days to follow-up of any kind between groups. Referrals to a heart failure home visiting program remained low overall (19.9%).
There was no significant difference in 30-day rehospitalisations or mortality between patients admitted to rural versus metropolitan hospitals. Geographical discrepancies were noted in follow-up by 30 days, with significantly more metropolitan patients having seen a doctor by 30 days post-discharge. Overall follow-up rates remain suboptimal.
急性失代偿性心力衰竭（ADHF）是 65 岁以上患者住院的最常见原因，在农村地区与大都市地区相比，预后较差。本研究旨在比较维多利亚州农村和大都市地区医院收治的 ADHF 患者的住院和出院后管理。
使用来自维多利亚州心脏结局登记处、心力衰竭（VCOR-HF）项目的数据。这是一项连续的前瞻性观察性非随机研究，纳入了在澳大利亚维多利亚州参与医院就诊的 ADHF 作为其主要诊断的连续患者，在连续四年的四个 30 天期间进行。所有患者均在出院后 30 天内进行随访。
在研究期间，共有 1357 名（1260 名大都市，97 名农村）患者因 ADHF 被收入研究医院。队列在年龄（平均 76.87±13.12 岁）和男性比例（总体 56.4%）方面相似。大都市患者更有可能患有糖尿病（44.4% vs 34.0%，p=0.046）、肾脏疾病（65.8% vs 37.1%，p<0.01）和贫血（31.9% vs 19.6%，p=0.01）。大都市和农村患者的住院时间无显著差异（7.49 天 vs 6.37 天，p=0.12）。大都市和农村患者在 30 天内再住院率（19.1% vs 11.6%，p=0.07）和全因 30 天死亡率（8.2% vs 4.1%，p=0.15）方面均无显著差异。大都市患者在 30 天内更有可能看全科医生（68.1% vs 53.2%，p<0.01）或看门诊（35.9% vs 10.6%，p<0.01）。两组之间任何类型的随访天数均无显著差异。总体上，向心力衰竭家庭访视计划的转诊率仍然很低（19.9%）。
农村和大都市地区入院的患者在 30 天内再住院率或死亡率方面无显著差异。在 30 天的随访方面存在地理差异，大都市地区的患者在出院后 30 天内看医生的比例明显更高。总的随访率仍然不理想。
