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比较 COVID-19 时代重组与未改变心内科的情况:COV-HF-SIRIO 6 研究的亚分析。

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: A subanalysis of the COV-HF-SIRIO 6 study.

机构信息

Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.

Department of Cardiology, Marian Zyndram-Kościałkowski Ministry of Interior and Administration Hospital, Białystok, Poland.

出版信息

Cardiol J. 2023;30(3):344-352. doi: 10.5603/CJ.a2023.0002. Epub 2023 Jan 18.

Abstract

BACKGROUND

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments.

METHODS

The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF).

RESULTS

Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55).

CONCLUSIONS

A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.

摘要

背景

自 2019 年冠状病毒病(COVID-19)大流行开始以来,许多心脏病学部门进行了重组,以提供 COVID-19 患者的护理。我们旨在比较 COVID-19 大流行对重组和未重组心脏病学部门的医院入院和院内死亡率的影响。

方法

本研究是一项多中心回顾性 COV-HF-SIRIO 6 研究的子分析,该研究纳入了 2019 年 1 月 1 日至 2020 年 12 月 31 日期间波兰 24 个心脏病学部门住院的所有患者(n=101433),重点关注急性心力衰竭(AHF)患者。

结果

与 2019 年相比,2020 年重组和未重组心脏病学部门的全因住院率分别下降 50.6%和 21.3%(p<0.0001)。仅考虑 AHF,相应的降幅分别为 46.5%和 15.2%(p<0.0001)。与未重组心脏病学部门相比,更多的患者通过救护车被送往重组心脏病学部门(51.7% vs. 34.6%;p<0.0001),同时自行转诊的比例较低(45.7% vs. 58.4%;p<0.0001)。在 AHF 患者中,因 COVID-19 相关死亡而导致的全因院内死亡率在重组心脏病学部门高于未重组心脏病学部门(10.9% vs. 6.4%;p<0.0001)。排除合并 COVID-19 的患者后,死亡率差异无统计学意义(6.9% vs. 6.4%;p=0.55)。

结论

与未重组的心脏病学部门相比,重组部门 2020 年与 2019 年相比,医院入院人数减少幅度更大,救护车接送患者的比例更高,自行转诊的比例更低,因 COVID-19 相关死亡而导致的 AHF 全因院内死亡率更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/622d/10287078/48009ffbff45/cardj-30-3-344f1.jpg

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