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充血性心力衰竭30天再入院:人口统计学、合并症、心力衰竭知识及自我护理的描述性研究

Congestive Heart Failure 30-Day Readmission: Descriptive Study of Demographics, Co-morbidities, Heart Failure Knowledge, and Self-Care.

作者信息

Madanat Luai, Saleh Monique, Maraskine Marina, Halalau Alexandra, Bukovec Florian

机构信息

Internal Medicine, Beaumont Hospital, Royal Oak, USA.

Cardiovascular Medicine, Beaumont Hospital, Royal Oak, USA.

出版信息

Cureus. 2021 Oct 11;13(10):e18661. doi: 10.7759/cureus.18661. eCollection 2021 Oct.

Abstract

Background Congestive heart failure (CHF) readmissions are associated with substantial financial and medical implications. We performed a descriptive study to determine demographic, clinical, and behavioral factors associated with 30-day readmission. Materials and methods Patients hospitalized with CHF at William Beaumont Hospital in Royal Oak, MI, from March 2019-May 2019 were studied. Response to heart failure knowledge and self-care questionnaires along with the patients' demographic and clinical factors were collected. Thirty-day readmission to any of the eight hospitals in the Beaumont Health System was documented. Results One-hundred ninety-six (196) patients were included. The all-cause 30-day readmission rate was 23%. A numerical higher rate of readmissions was observed among males (23.7% vs 22.2%), current smokers (27.3% vs 22.9%), and patients with peripheral vascular disease (PVD; 28.9% vs 21.2%), diabetes mellitus (DM; 26.4% vs 18.9%), hypertension (HTN; 26.4% vs 10%), coronary artery disease (CAD; 24.6% vs 19%), and prior history of cerebrovascular accident (CVA; 28.9% vs 21.2%) (p>0.05). Reduced left ventricular ejection fraction (LVEF) was associated with higher readmissions (24.4% vs 20.5%, p=0.801). Patients with the highest reported questionnaire scores corresponding to better heart failure knowledge and self-care behaviors at home were readmitted at a similar rate compared to those scoring in the lowest interval (25%, p=0.681). Conclusion Though statistically insignificant due to the limitations of sample size, a higher percentage of readmissions was observed in male patients, current smokers, reduced LVEF, and higher comorbidity burden. Better reported patient self-care behavior, medication compliance, and heart failure knowledge did not correlate with reduced readmission rates. While the impact of medical comorbidities on 30-day readmissions is better established, the role of socioeconomic factors remains unclear and might suggest a focus for future work.

摘要

背景 充血性心力衰竭(CHF)再入院与巨大的经济和医疗影响相关。我们进行了一项描述性研究,以确定与30天再入院相关的人口统计学、临床和行为因素。材料与方法 对2019年3月至2019年5月在密歇根州罗亚尔奥克市威廉·博蒙特医院因CHF住院的患者进行研究。收集了患者对心力衰竭知识和自我护理问卷的回答以及患者的人口统计学和临床因素。记录了在博蒙特医疗系统的八家医院中任何一家的30天再入院情况。结果 纳入了196例患者。全因30天再入院率为23%。在男性(23.7%对22.2%)、当前吸烟者(27.3%对22.9%)、患有外周血管疾病(PVD;28.9%对21.2%)、糖尿病(DM;26.4%对18.9%)、高血压(HTN;26.4%对10%)、冠状动脉疾病(CAD;24.6%对19%)和有脑血管意外(CVA)既往史(28.9%对21.2%)的患者中观察到再入院率在数值上更高(p>0.05)。左心室射血分数(LVEF)降低与更高的再入院率相关(24.4%对20.5%,p=0.801)。报告的问卷得分最高(对应在家中更好的心力衰竭知识和自我护理行为)的患者与得分在最低区间的患者再入院率相似(25%,p=0.681)。结论 尽管由于样本量的限制在统计学上无显著意义,但在男性患者、当前吸烟者、LVEF降低和合并症负担较高的患者中观察到再入院率较高。报告的患者自我护理行为、药物依从性和心力衰竭知识较好与再入院率降低无关。虽然医疗合并症对30天再入院的影响已得到更好的确立,但社会经济因素的作用仍不清楚,这可能提示未来工作的重点。

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