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基于性别的心脏骤停后 30 天再入院差异:全国再入院数据库分析。

Sex-Based Differences in 30-Day Readmissions After Cardiac Arrest: Analysis of the Nationwide Readmissions Database.

机构信息

Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY.

Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY.

出版信息

J Am Heart Assoc. 2022 Sep 20;11(18):e025779. doi: 10.1161/JAHA.122.025779. Epub 2022 Sep 8.

Abstract

Background There are limited data on the sex-based differences in the outcome of readmission after cardiac arrest. Methods and Results Using the Nationwide Readmissions Database, we analyzed patients hospitalized with cardiac arrest between 2010 and 2015. Based on () codes, we identified comorbidities, therapeutic interventions, and outcomes. Multivariable logistic regression was performed to assess the independent association between sex and outcomes. Of 835 894 patients, 44.4% (n=371 455) were women, of whom 80.7% presented with pulseless electrical activity (PEA)/asystole. Women primarily presented with PEA/asystole (80.7% versus 72.4%) and had a greater comorbidity burden than men, as assessed using the Elixhauser Comorbidity Score. Thirty-day readmission rates were higher in women than men in both PEA/asystole (20.8% versus 19.6%) and ventricular tachycardia/ventricular fibrillation arrests (19.4% versus 17.1%). Among ventricular tachycardia/ventricular fibrillation arrest survivors, women were more likely than men to be readmitted because of noncardiac causes, predominantly infectious, respiratory, and gastrointestinal illnesses. Among PEA/asystole survivors, women were at higher risk for all-cause (adjusted odds ratio [aOR], 1.07; [95% CI, 1.03-1.11]), cardiac-cause (aOR, 1.15; [95% CI, 1.06-1.25]), and noncardiac-cause (aOR, 1.13; [95% CI, 1.04-1.22]) readmission. During the index hospitalization, women were less likely than men to receive therapeutic procedures, including coronary angiography and targeted therapeutic management. While the crude case fatality rate was higher in women, in both ventricular tachycardia/ventricular fibrillation (51.8% versus 47.4%) and PEA/asystole (69.3% versus 68.5%) arrests, sex was not independently associated with increased crude case fatality after adjusting for differences in baseline characteristics. Conclusions Women are at increased risk of readmission following cardiac arrest, independent of comorbidities and therapeutic interventions.

摘要

背景

目前关于心搏骤停后再入院结局的性别差异的数据有限。

方法和结果

我们使用全国再入院数据库,分析了 2010 年至 2015 年期间因心搏骤停住院的患者。根据 ICD-10 编码,我们确定了合并症、治疗干预措施和结局。采用多变量逻辑回归评估性别与结局之间的独立关联。在 835894 例患者中,44.4%(n=371455)为女性,其中 80.7%表现为无脉电活动(PEA)/心搏停止。女性主要表现为 PEA/心搏停止(80.7%比 72.4%),并且 Elixhauser 合并症评分评估的合并症负担大于男性。PEA/心搏停止(20.8%比 19.6%)和室性心动过速/心室颤动骤停(19.4%比 17.1%)患者的 30 天再入院率女性高于男性。在室性心动过速/心室颤动骤停存活者中,女性因非心脏原因再入院的可能性高于男性,主要是感染、呼吸和胃肠道疾病。在 PEA/心搏停止存活者中,女性发生全因(调整后优势比[OR],1.07;[95%CI,1.03-1.11])、心脏原因(调整后 OR,1.15;[95%CI,1.06-1.25])和非心脏原因(调整后 OR,1.13;[95%CI,1.04-1.22])再入院的风险更高。在住院期间,女性接受治疗性操作的可能性低于男性,包括冠状动脉造影和有针对性的治疗管理。虽然女性的粗病死率较高,但在室性心动过速/心室颤动(51.8%比 47.4%)和 PEA/心搏停止(69.3%比 68.5%)骤停中,性别在调整基线特征差异后与增加的粗病死率无关。

结论

心搏骤停后,女性再入院的风险增加,与合并症和治疗干预无关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/394e/9683669/1505afd6f5ed/JAH3-11-e025779-g003.jpg

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