Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
J Am Coll Cardiol. 2022 Jul 12;80(2):111-122. doi: 10.1016/j.jacc.2022.04.045.
There is growing interest to disentangle worsening heart failure (WHF) from location of care and move away from hospitalization as a surrogate for acuity.
The purpose of this study was to describe the incidence of WHF events across the care continuum from ambulatory encounters to hospitalizations.
We studied calendar year cohorts of adults with diagnosed heart failure (HF) from 2010-2019 within a large, integrated health care delivery system. Electronic health record (EHR) data were accessed for outpatient encounters, emergency department (ED) visits/observation stays, and hospitalizations. WHF was defined as ≥1 symptom, ≥2 objective findings including ≥1 sign, and ≥1 change in HF-related therapy. Symptoms and signs were ascertained using natural language processing.
We identified 103,138 eligible individuals with mean age 73.6 ± 13.7 years, 47.5% women, and mean left ventricular ejection fraction of 51.4% ± 13.7%. There were 1,136,750 unique encounters including 743,039 (65.4%) outpatient encounters, 224,670 (19.8%) ED visits/observation stays, and 169,041 (14.9%) hospitalizations. A total of 126,008 WHF episodes were identified, including 34,758 (27.6%) outpatient encounters, 28,301 (22.5%) ED visits/observation stays, and 62,949 (50.0%) hospitalizations. The annual incidence (events per 100 person-years) of WHF increased from 25 to 33 during the study period primarily caused by outpatient encounters (7 to 10) and ED visits/observation stays (4 to 7). The 30-day rate of hospitalizations for WHF ranged from 8.2% for outpatient encounters to 12.4% for hospitalizations.
ED visits/observation stays and outpatient encounters account for approximately one-half of WHF events, are driving the underlying growth in HF morbidity, and portend a poor short-term prognosis.
人们越来越关注将心力衰竭恶化（WHF）与治疗地点区分开来，不再将住院作为严重程度的替代指标。
本研究旨在描述从门诊就诊到住院治疗的连续护理过程中 WHF 事件的发生率。
我们在一个大型综合医疗服务提供系统中，对 2010 年至 2019 年期间患有确诊心力衰竭（HF）的成年人进行了日历年度队列研究。使用电子健康记录（EHR）数据获取门诊就诊、急诊就诊/观察留观和住院治疗的信息。WHF 定义为≥1 个症状，≥2 个客观表现，包括≥1 个体征，和≥1 项 HF 相关治疗的改变。症状和体征通过自然语言处理来确定。
我们确定了 103138 名符合条件的个体，平均年龄为 73.6 ± 13.7 岁，47.5%为女性，平均左心室射血分数为 51.4% ± 13.7%。共有 1136750 个独特的就诊记录，其中 743039 次（65.4%）为门诊就诊，224670 次（19.8%）为急诊就诊/观察留观，169041 次（14.9%）为住院治疗。共发现 126008 例 WHF 发作，其中 34758 次（27.6%）为门诊就诊，28301 次（22.5%）为急诊就诊/观察留观，62949 次（50.0%）为住院治疗。在研究期间，WHF 的年发生率（每 100 人年事件数）从 25 例增加到 33 例，主要原因是门诊就诊（从 7 例增加到 10 例）和急诊就诊/观察留观（从 4 例增加到 7 例）。WHF 住院的 30 天内再住院率范围为门诊就诊的 8.2%至住院治疗的 12.4%。
急诊就诊/观察留观和门诊就诊约占 WHF 事件的一半，是 HF 发病率增加的主要原因，并预示着短期预后不良。
