Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
ESC Heart Fail. 2022 Jun;9(3):1920-1930. doi: 10.1002/ehf2.13898. Epub 2022 Mar 15.
There is a scarcity of data on the post-discharge prognosis in acute heart failure (AHF) patients with a low-income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance.
The Kyoto Congestive Heart Failure registry was a physician-initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow-up of 470 days, the cumulative 1 year incidences of all-cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all-cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69-1.32; P = 0.84]. Even after taking into account the competing risk of all-cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64-1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07-2.29; P = 0.02).
The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all-cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge.
https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).
在接受公共援助的低收入急性心力衰竭（AHF）患者中，关于出院后预后的数据稀缺。本研究旨在评估接受公共援助和未接受公共援助的 AHF 患者之间的临床特征和结局差异。
京都充血性心力衰竭注册研究是一项由医师发起的前瞻性观察性多中心队列研究，纳入了 2014 年 10 月至 2016 年 3 月期间首次因 AHF 住院的 4056 例连续患者。本研究人群包括 3728 例从指数 AHF 住院中存活出院的患者。我们将患者分为两组，一组接受公共援助，另一组未接受公共援助。在评估公共援助作为变量的比例风险假设后，我们构建了多变量 Cox 比例风险模型来估计公共援助组相对于无公共援助组的风险。有 218 例（5.8%）患者接受公共援助，3510 例（94%）未接受公共援助。与无公共援助组相比，公共援助组患者更年轻，更频繁地患有慢性冠状动脉疾病、既往心力衰竭住院、当前吸烟、药物依从性差、独居、无职业和左心室射血分数较低。在中位数为 470 天的随访期间，出院后全因死亡和心力衰竭住院的 1 年累积发生率在公共援助组和无公共援助组之间没有差异（13.3%对 17.4%，P=0.10；28.3%对 23.8%，P=0.25）。在校正混杂因素后，公共援助组相对于无公共援助组的全因死亡风险仍无显著差异[风险比（HR），0.97；95%置信区间（CI），0.69-1.32；P=0.84]。即使考虑到全因死亡的竞争风险，公共援助组在 180 天内相对于无公共援助组的心衰住院风险也无显著差异（HR，0.93；95%CI，0.64-1.34；P=0.69），而超过 180 天后的调整风险显著（HR，1.56；95%CI，1.07-2.29；P=0.02）。
与未接受公共援助的患者相比，接受公共援助的 AHF 患者出院后 1 年全因死亡或出院后 180 天内心力衰竭住院的风险无显著增加，但出院后 180 天以上心力衰竭住院的风险显著增加。
https://clinicaltrials.gov/ct2/show/NCT02334891（NCT02334891）和 https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi？recptno=R000017241（UMIN000015238）。
