Heart, Thoracic and Vascular InstituteCleveland Clinic Foundation Cleveland OH.
Division of Cardiology Warren Alpert Medical School of Brown UniversityLifespan Cardiovascular Institute Providence RI.
J Am Heart Assoc. 2022 May 17;11(10):e025342. doi: 10.1161/JAHA.122.025342. Epub 2022 May 10.
Background Readmission occurs in 1 out of 3 patients with heart failure (HF). We aimed to study the incidence and prognostic implications of rehospitalizations because of arterial thromboembolism events (ATEs) and venous thromboembolism events (VTEs) after discharge in patients with HF. Methods and Results We identified Medicare beneficiaries who were admitted with a primary diagnosis of HF from 2014 to 2019, with a hospital stay ranging between 3 and10 days, followed by discharge to home. We calculated incidence of ATEs (myocardial infarction, ischemic stroke, or systemic embolism) and VTEs (deep venous thrombosis and pulmonary embolism) up to 90 days after discharge. Out of 2 953 299 patients admitted with HF during the study period, a total of 585 353 patients met the inclusion criteria, and 36.6% were readmitted within 90 days of discharge. The incidence of readmission due ATEs, VTEs, HF, and all other reasons was 3.4%, 0.5%, 13.2%, and 19.5%, respectively. Incidence of thromboembolic events was highest within 14 days after discharge. Factors associated with ATEs included prior coronary, peripheral, or cerebrovascular disease and for VTEs included malignancy and prior liver or lung disease. ATE/VTE readmission had a 30-day mortality of 19.9%. After a median follow-up period of 25.6 months, ATE and VTE readmissions were associated with higher risk of mortality (hazard ratio, 2.76 [95% CI, 2.71-2.81] and 2.17 [95% CI, 2.08-2.27], respectively; <0.001 for both) compared with no readmission on time-dependent Cox regression. Conclusions After a HF hospitalization, 3.9% of patients were readmitted with a thromboembolic event that was associated with 2- to 3-fold greater risk of mortality in follow-up.
心力衰竭（HF）患者中有 1/3 会在出院后再次入院。我们旨在研究 HF 患者出院后因动脉血栓栓塞事件（ATE）和静脉血栓栓塞事件（VTE）而再入院的发生率和预后意义。
我们确定了 2014 年至 2019 年期间因 HF 初次住院且住院时间在 3 至 10 天之间，随后出院回家的 Medicare 受益人的资料。我们计算了出院后 90 天内 ATE（心肌梗死、缺血性卒中和全身性栓塞）和 VTE（深静脉血栓形成和肺栓塞）的发生率。在研究期间，有 2953299 名 HF 患者入院，共有 585353 名患者符合纳入标准，其中 36.6%在出院后 90 天内再次入院。ATE、VTE、HF 和其他所有原因的再入院发生率分别为 3.4%、0.5%、13.2%和 19.5%。血栓栓塞事件的发生率在出院后 14 天内最高。ATE 的发生与既往的冠状动脉、外周血管或脑血管疾病相关，而 VTE 的发生与恶性肿瘤以及既往的肝脏或肺部疾病相关。ATE/VTE 再入院的 30 天死亡率为 19.9%。在中位随访 25.6 个月后，ATE 和 VTE 再入院与更高的死亡风险相关（风险比，2.76[95%CI，2.71-2.81]和 2.17[95%CI，2.08-2.27]；两者均<0.001），与按时再入院相比，在时间依赖性 Cox 回归分析中。
HF 住院治疗后，3.9%的患者因血栓栓塞事件而再入院，这与随访中 2 至 3 倍的死亡率增加相关。
