Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA.
Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Am Heart J. 2022 Apr;246:65-73. doi: 10.1016/j.ahj.2021.11.021. Epub 2021 Dec 16.
We aimed to evaluate the influence of heart failure (HF) on clinical and economic outcomes among older adults ≥75 years of age during their acute myocardial infarction (AMI) admission in large population-based study from the United States. We also evaluated the clinical characteristics associated with the presence of HF and the predictors of mortality, healthcare utilization, and cost among older adults with AMI.
From January 1, 2000, to December 31, 2016, AMI admission was identified using the primary diagnosis and concomitant HF was identified using any non-primary diagnoses in the Premier Healthcare Database.
Of the 468,654 patients examined, 42,946 (9%) had concomitant HF during their AMI admission. These patients were older, more often female, and were more likely to be White. Patients with concomitant HF were more likely to be frail than non-HF patients (59% vs 15%, P < .001). The mean (SD) Elixhauser comorbidity index was 2.6 (2.5) vs 0.4 (1.1), P < .001 in the AMI with HF vs AMI only group. The use of percutaneous coronary intervention in those with AMI and HF was lower than those with AMI only (15% vs 31%, P < .001). The overall mortality rate for those with HF was 12%, the median [IQR] hospital length of stay was 5 [3,9] days, and only 25% of patients were discharged home. A higher proportion of patients were discharged to rehabilitation or hospice if they had AMI and HF (Rehabilitation: 33% vs 20%, P < .001; Hospice: 5% vs 3%, P < .001). The mean unadjusted cost of an AMI hospitalization in patients with concomitant HF was lower ($12,411 ± $14,860) than in those without HF ($15,828 ± $19,330). After adjusting for age, gender, race, hypertension, frailty, revascularization strategy, and death, the average cost of hospitalization attributed to concomitant HF was +$1,075 (95% CI +876 to $1,274) when compared to AMI patients without HF.
In patients ≥75 years of age, AMI with concomitant HF carries higher risk of death, but at ages ≥85 years, the risk difference diminishes due to other competing risks. HF was also associated with longer hospital length of stay and higher likelihood of referral to hospice and rehabilitation facilities when compared to older patients without HF. Care for these older adults is associated with increased hospitalization costs. Measures to identify HF in older adults during their AMI admission are necessary to optimize health outcomes, care delivery, and costs.
我们旨在评估心力衰竭（HF）对美国大型基于人群研究中≥75 岁老年人急性心肌梗死（AMI）入院期间临床和经济结局的影响。我们还评估了与 HF 并存的临床特征以及与 AMI 老年患者死亡率、医疗保健利用和成本相关的预测因素。
从 2000 年 1 月 1 日至 2016 年 12 月 31 日，使用主要诊断确定 AMI 入院，使用 Premier Healthcare Database 中的任何非主要诊断确定 HF 并存。
在检查的 468654 名患者中，有 42946 名（9%）在 AMI 入院期间同时患有 HF。这些患者年龄较大，女性较多，且更可能为白人。与非 HF 患者相比，HF 并存患者更容易衰弱（59%比 15%，P<.001）。AMI 伴 HF 组的平均（SD）Elixhauser 合并症指数为 2.6（2.5），而 AMI 仅组为 0.4（1.1），P<.001。与 AMI 仅组相比，AMI 伴 HF 患者经皮冠状动脉介入治疗的使用率较低（15%比 31%，P<.001）。HF 患者的总体死亡率为 12%，中位数[IQR]住院时间为 5[3,9]天，只有 25%的患者出院回家。如果 AMI 伴 HF，更多的患者出院至康复或临终关怀（康复：33%比 20%，P<.001；临终关怀：5%比 3%，P<.001）。HF 并存患者的 AMI 住院治疗未经调整的平均费用较低（$12411 ± $14860），而无 HF 的患者为（$15828 ± $19330）。在校正年龄、性别、种族、高血压、衰弱、血运重建策略和死亡后，与无 HF 的 AMI 患者相比，HF 并存导致的住院治疗平均费用增加了 +$1075（95%CI +876 至 +1274）。
在≥75 岁的患者中，AMI 伴 HF 具有更高的死亡风险，但在≥85 岁的患者中，由于其他竞争风险，风险差异会减小。与无 HF 的老年患者相比，HF 还与住院时间延长和更有可能转至临终关怀和康复机构有关。对这些老年患者的护理与住院费用增加有关。在 AMI 入院期间识别 HF 的措施对于优化健康结局、护理提供和成本至关重要。
