Lim Yvonne Mei Fong, Ong Su Miin, Koudstaal Stefan, Hwong Wen Yea, Liew Houng Bang, Rajadurai Jeyamalar, Grobbee Diederick E, Asselbergs Folkert W, Sivasampu Sheamini, Vaartjes Ilonca
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.
Glob Heart. 2022 Mar 8;17(1):20. doi: 10.5334/gh.1108. eCollection 2022.
Data on population-level outcomes after heart failure (HF) hospitalisation in Asia is sparse. This study aimed to estimate readmission and mortality after hospitalisation among HF patients and examine temporal variation by sex and ethnicity.
Data for 105,399 patients who had incident HF hospitalisations from 2007 to 2016 were identified from a national discharge database and linked to death registration records. The outcomes assessed here were 30-day readmission, in-hospital, 30-day and one-year all-cause mortality.
Eighteen percent of patients (n = 16786) were readmitted within 30 days. Mortality rates were 5.3% (95% confidence interval (CI) 5.1-5.4%), 11.2% (11.0-11.4%) and 33.1% (32.9-33.4%) for in-hospital, 30-day and 1-year mortality after the index admission. Age, sex and ethnicity-adjusted 30-day readmissions increased by 2% per calendar year while in-hospital and 30-day mortality declined by 7% and 4% per year respectively. One-year mortality rates remained constant during the study period. Men were at higher risk of 30-day readmission (adjusted rate ratio (RR) 1.16, 1.13-1.20) and one-year mortality (RR 1.17, 1.15-1.19) than women. Ethnic differences in outcomes were evident. Readmission rates were equally high in Chinese and Indians relative to Malays whereas Others, which mainly comprised Indigenous groups, fared worst for in-hospital and 30-day mortality with RR 1.84 (1.64-2.07) and 1.3 (1.21-1.41) relative to Malays.
Short-term survival was improving across sex and ethnic groups but prognosis at one year after incident HF hospitalisation remained poor. The steady increase in 30-day readmission rates deserves further investigation.
亚洲地区心力衰竭（HF）住院后人群水平结局的数据较为稀少。本研究旨在估计HF患者住院后的再入院率和死亡率，并按性别和种族考察时间变化情况。
从国家出院数据库中识别出2007年至2016年发生HF住院的105399例患者的数据，并与死亡登记记录相链接。此处评估的结局为30天再入院率、住院期间、30天和1年全因死亡率。
18%的患者（n = 16786）在30天内再次入院。住院期间、30天和1年死亡率分别为5.3%（95%置信区间（CI）5.1 - 5.4%）、11.2%（11.0 - 11.4%）和33.1%（32.9 - 33.4%）。经年龄、性别和种族调整后，30天再入院率每年增加2%，而住院期间和30天死亡率分别每年下降7%和4%。在研究期间，1年死亡率保持稳定。男性30天再入院风险（调整率比（RR）1.16，1.13 - 1.20）和1年死亡率（RR 1.17，1.15 - 1.19）高于女性。结局的种族差异明显。相对于马来人，华人和印度人的再入院率同样较高，而主要由原住民群体组成的“其他”种族在住院期间和30天死亡率方面表现最差，相对于马来人的RR分别为1.84（1.64 - 2.07）和1.3（1.21 - 1.41）。
各性别和种族群体的短期生存率均有所提高，但HF首次住院后1年的预后仍然较差。30天再入院率的稳步上升值得进一步研究。
