Eguchi Shunsuke, Morita Yohei, Mitani Hironobu, Kanegasaki Ayako, Iwasaki Kosuke, Yoshikawa Tsutomu, Kitagawa Hiroshi, Oyama Naotsugu
Cardio-Renal-Metabolism Medical Franchise Department, Medical Division, Novartis Pharma K.K., Toranomon Hills Mori Tower, 1-23-1 Toranomon, Minato-ku, Tokyo, 105-6333, Japan.
Milliman, Inc., Tokyo, Japan.
Drugs Real World Outcomes. 2022 Sep;9(3):377-389. doi: 10.1007/s40801-022-00315-5. Epub 2022 Jun 26.
Repeated hospitalization is a predictor of outcomes in heart failure, indicating the presence of symptoms, a deteriorated condition at pre-admission, and worsened prognosis.
The current database study aimed to understand the clinical and economic burden of repeated hospitalizations among patients with heart failure in Japan. The effect of repeated hospitalizations on the subsequent in-hospital mortality was the primary objective; economic burden of heart failure after discharge was investigated as a secondary outcome.
Between 2013 and 2018, administrative claims and discharge summary data of patients aged ≥ 20 years and diagnosed with heart failure were obtained from a Diagnosis Procedure Combination database maintained by Medical Data Vision. Hospitalization, mortality, and economic burden data were analyzed.
This study included 49,094 patients. The mean length of the first hospital stay was 22.9 days. The in-hospital mortality rate was approximately 10%, with one to five repeated hospitalizations. The time interval between repeated hospitalizations for heart failure decreased with an increasing number of hospitalizations. In-hospital mortality did not increase even with an increasing number of hospitalizations. The mean heart failure-related healthcare cost per patient was ¥564,281 ± 990,447 (US$5178 ± 9,088), 67.3% of which was hospitalization costs. Among hospitalization costs, other costs were high, mainly for basic hospitalization fees (71.7%; ¥233,146/person-year).
Repeated hospitalization did not increase in-hospital mortality; however, it may shorten the intervals between heart failure-related hospitalizations, potentially caused by deterioration of the patient's condition, and increase the clinical and economic burden on patients.
反复住院是心力衰竭预后的一个预测指标，表明存在症状、入院前病情恶化以及预后变差。
当前的数据库研究旨在了解日本心力衰竭患者反复住院的临床和经济负担。反复住院对随后住院死亡率的影响是主要目标；出院后心力衰竭的经济负担作为次要结果进行调查。
2013年至2018年期间，从Medical Data Vision维护的诊断程序组合数据库中获取年龄≥20岁且诊断为心力衰竭患者的行政索赔和出院总结数据。对住院、死亡率和经济负担数据进行分析。
本研究纳入了49094例患者。首次住院的平均时长为22.9天。一至五次反复住院的住院死亡率约为10%。心力衰竭反复住院之间的时间间隔随着住院次数的增加而缩短。即使住院次数增加，住院死亡率也没有上升。每位患者心力衰竭相关的平均医疗费用为564,281日元±990,447日元（5178美元±9088美元），其中67.3%为住院费用。在住院费用中，其他费用较高，主要是基本住院费用（71.7%；每人每年233,146日元）。
反复住院并未增加住院死亡率；然而，它可能会缩短心力衰竭相关住院之间的间隔，这可能是由患者病情恶化导致的，并增加患者的临床和经济负担。
