Jha Anil Kumar, Ojha Chandra P, Krishnan Anand M, Paul Timir K
Internal Medicine, Lowell General Hospital, Lowell, MA 01852, United States.
Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States.
World J Cardiol. 2022 Sep 26;14(9):473-482. doi: 10.4330/wjc.v14.i9.473.
There are rising numbers of patients who have heart failure with preserved ejection fraction (HFpEF). Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies, the management of HFpEF is challenging.
To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.
We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project, Nationwide Readmissions Database for the year 2017. We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF. The primary outcome was the rate of all-cause readmission within 30 d of discharge. Secondary outcomes were cause of readmission, mortality rate in readmitted and index patients, length of stay, total hospitalization costs and charges. Independent risk factors for readmission were identified using Cox regression analysis.
The thirty day readmission rate was 21%. Approximately 9.17% of readmissions were in the setting of acute on chronic diastolic heart failure. Hypertensive chronic kidney disease with heart failure (1245; 9.7%) was the most common readmission diagnosis. Readmitted patients had higher in-hospital mortality (7.9% 2.9%, = 0.000). Our study showed that Medicaid insurance, higher Charlson co-morbidity score, patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates. Lower readmission rate was found in residents of small metropolitan or micropolitan areas, older age, female gender, and private insurance or no insurance were associated with lower risk of readmission.
We found that patients hospitalized for acute or acute on chronic HFpEF, the thirty day readmission rate was 21%. Readmission cases had a higher mortality rate and increased healthcare resource utilization. The most common cause of readmission was cardio-renal syndrome.
射血分数保留的心力衰竭（HFpEF）患者数量不断增加。射血分数保留和降低的心力衰竭的病理生理学尚不清楚，且由于研究较少，HFpEF的管理具有挑战性。
确定美国射血分数保留的急性或慢性心力衰竭急性发作后30天内的医院再入院率及其对死亡率和医疗负担的影响。
我们使用医疗保健研究与质量局的医疗保健成本和利用项目、2017年全国再入院数据库进行了一项回顾性研究。我们收集了60514名因急性或慢性HFpEF住院的成年人的医院再入院数据。主要结局是出院后30天内全因再入院率。次要结局是再入院原因、再入院患者和索引患者的死亡率、住院时间、总住院费用和收费。使用Cox回归分析确定再入院的独立危险因素。
30天再入院率为21%。约9.17%的再入院发生在慢性舒张性心力衰竭急性发作的情况下。高血压合并慢性肾病伴心力衰竭（1245例；9.7%）是最常见的再入院诊断。再入院患者的院内死亡率更高（7.9%对2.9%，P = 0.000）。我们的研究表明，医疗补助保险、较高的查尔森合并症评分、入住教学医院的患者以及较长的住院时间是与较高再入院率相关的显著变量。在小都市或微型都市地区的居民中发现再入院率较低，年龄较大、女性以及私人保险或无保险与较低的再入院风险相关。
我们发现，因急性或慢性HFpEF住院的患者，30天再入院率为21%。再入院病例的死亡率更高，医疗资源利用率增加。再入院的最常见原因是心肾综合征。
