Department of Clinical Pharmacy, Hospital Group Twente, Almelo and Hengelo, The Netherlands.
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
Int J Clin Pharm. 2022 Jun;44(3):762-768. doi: 10.1007/s11096-022-01418-3. Epub 2022 May 28.
Background Among heart failure (HF) patients, hospital readmissions are a major concern. The medication taken by a patient may provide information on comorbidities and conditions and may be used as an indicator to identify populations at an increased risk of HF readmission. Aim This study explored the use of non-cardiovascular medication at hospital discharge from the first HF admission in search of indicators of high risk of readmission for HF. Method The study included 22,476 HF patients from the Dutch PHARMO Database Network at their first HF hospitalization. The data was divided into training and validation sets. A Cox regression model with demographics, date of first HF hospital admission and non-cardiovascular medication present at discharge, adjusted for cardiovascular medication, was developed in the training set and subsequently implemented in the validation set. Results The study included 22,476 patients, mean age 76.7 years (range 18-104) and median follow-up time 2.5 years (range 0-15.7 years). During the study period 6,725 (29.9%) patients were readmitted for HF, with a median time-to-readmission of 7 months (range 0-14.3 years). Non-cardiovascular medication associated with a high risk of readmission for HF were identified as indicators of high risk, with no implied causal relationship. Patients prescribed antigout medications presented a 25% increased risk of readmission (HR 1.25, 95%CI 1.09-1.45, P = 0.002). Patients using insulin had an 18% higher risk of readmission versus patients not using insulin (HR 1.18, 95%CI 1.06-1.32, P = 0.002), but not versus patients treated with other blood-glucose-lowering drugs. No association between the risk of readmission and NSAIDs use was observed. Conclusion The results suggest that diabetes is responsible for the higher HF-readmission risk observed in patients prescribed insulin. The observed risk in users of antigout medication should be further investigated. The absence of an association with the use of NSAIDs should be interpreted with caution.
在心力衰竭（HF）患者中，医院再入院是一个主要问题。患者所服用的药物可以提供合并症和状况的信息，并可作为识别 HF 再入院风险增加人群的指标。目的：本研究探讨了首次 HF 入院出院时使用非心血管药物，以寻找 HF 再入院高危的指标。方法：本研究纳入了荷兰 PHARMO 数据库网络中 22476 例首次 HF 住院的 HF 患者。将数据分为训练集和验证集。在训练集中建立了包含人口统计学、首次 HF 住院日期和出院时存在的非心血管药物的 Cox 回归模型，并根据心血管药物进行了调整，然后在验证集中实施了该模型。结果：本研究共纳入 22476 例患者，平均年龄 76.7 岁（范围 18-104 岁），中位随访时间 2.5 年（范围 0-15.7 年）。在研究期间，6725 例（29.9%）患者因 HF 再次入院，中位再入院时间为 7 个月（范围 0-14.3 年）。确定与 HF 再入院风险较高相关的非心血管药物作为高风险的指标，但并不意味着存在因果关系。使用抗痛风药物的患者再入院风险增加 25%（HR 1.25，95%CI 1.09-1.45，P=0.002）。与未使用胰岛素的患者相比，使用胰岛素的患者再入院风险增加 18%（HR 1.18，95%CI 1.06-1.32，P=0.002），但与使用其他降血糖药物的患者相比则不然。未观察到 NSAIDs 使用与再入院风险之间存在关联。结论：结果表明，糖尿病是导致使用胰岛素的患者 HF 再入院风险增加的原因。应进一步研究使用抗痛风药物的患者观察到的风险。对 NSAIDs 使用与再入院风险之间缺乏关联的解释应持谨慎态度。
