Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy.
Int J Cardiol. 2022 Sep 15;363:111-118. doi: 10.1016/j.ijcard.2022.06.052. Epub 2022 Jun 18.
Hospital readmissions are a key determinant of prognosis in elderly patients with heart failure (HF). We investigated their frequency, predictors and prognostic impact using a large administrative database from Liguria, the oldest region of Italy.
Patients aged ≥18 years with at least one hospitalization with HF and being prescribed a diuretic medication between January 2013 and December 2017 were included in the analysis. Their demographics and Charlson comorbidity index (CCI) were collected. Patients were grouped by number of readmissions, and negative binomial and Cox proportional hazard models were used to explore independent predictors of readmissions and mortality, respectively.
There were 207,130 hospital admissions from 35,316 patients (mean age 81.6 years, 43.7% ≥85 years of age, 47.2% male, mean CCI 1.7, overall mortality 52.8%). About a quarter of patients (8.878, 25.1%) had more than eight readmissions during follow-up, for a total of 108.146 admissions (52.2% of admissions). Male gender, lower educational level and higher CCI were independently associated with increased number of readmissions and increased mortality. There was an independent inverse relationship between number of admissions and survival, with patients hospitalized 8 or more times displaying a 3-fold increase in mortality, and a significant interaction between older age and readmissions on mortality.
A quarter of older comorbid HF patients contributed to more than half of HF hospital readmissions recorded over a 5-year period in Liguria, with a dismal impact on prognosis. Aging societies should pay greater attention to this matter and personalized disease-management programs should be implemented.
医院再入院是影响老年心力衰竭（HF）患者预后的一个关键因素。我们使用来自意大利最古老的地区利古里亚的大型行政数据库，研究了其频率、预测因素和预后影响。
纳入了年龄≥18 岁、至少有一次因 HF 住院且在 2013 年 1 月至 2017 年 12 月期间开利尿剂药物的患者。收集了他们的人口统计学资料和 Charlson 合并症指数（CCI）。根据再入院次数将患者分组，分别使用负二项和 Cox 比例风险模型来探索再入院和死亡的独立预测因素。
从 35316 名患者中共有 207130 例住院（平均年龄 81.6 岁，≥85 岁占 43.7%，男性占 47.2%，平均 CCI 为 1.7，总死亡率为 52.8%）。大约四分之一的患者（8.878，25.1%）在随访期间有超过 8 次再入院，共 108146 次入院（占入院总次数的 52.2%）。男性、较低的教育水平和较高的 CCI 与再入院次数的增加和死亡率的增加独立相关。入院次数与生存率呈独立的反比关系，住院 8 次以上的患者死亡率增加 3 倍，年龄较大和再入院次数对死亡率有显著的交互作用。
在利古里亚，五分之一的老年 HF 合并症患者占 HF 住院再入院的一半以上，对预后有不利影响。老龄化社会应更加重视这一问题，并实施个性化的疾病管理计划。
