Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
J Am Coll Cardiol. 2023 Aug 1;82(5):430-444. doi: 10.1016/j.jacc.2023.05.040.
Heart failure (HF) readmission rates are low in some jurisdictions. However, international comparisons are lacking and could serve as a foundation for identifying regional patient management strategies that could be shared to improve outcomes.
This study sought to summarize 30-day and 1-year all-cause readmission and mortality rates of hospitalized HF patients across countries and to explore potential differences in rates globally.
We performed a systematic review and meta-analysis using MEDLINE, Embase, and CENTRAL for observational reports on hospitalized adult HF patients at risk for readmission or mortality published between January 2010 and March 2021. We conducted a meta-analysis of proportions using a random-effects model, and sources of heterogeneity were evaluated with meta-regression.
In total, 24 papers reporting on 30-day and 23 papers on 1-year readmission were included. Of the 1.5 million individuals at risk, 13.2% (95% CI: 10.5%-16.1%) were readmitted within 30 days and 35.7% (95% CI: 27.1%-44.9%) within 1 year. A total of 33 papers reported on 30-day and 45 papers on 1-year mortality. Of the 1.5 million individuals hospitalized for HF, 7.6% (95% CI: 6.1%-9.3%) died within 30 days and 23.3% (95% CI: 20.8%-25.9%) died within 1 year. Substantial variation in risk across countries was unexplained by countries' gross domestic product, proportion of gross domestic product spent on health care, and Gini coefficient.
Globally, hospitalized HF patients exhibit high rates of readmission and mortality, and the variability in readmission rates was not explained by health care expenditure, risk of mortality, or comorbidities.
心力衰竭（HF）的再入院率在某些司法管辖区较低。然而，国际比较缺乏，可作为确定区域患者管理策略的基础，这些策略可以共享以改善结果。
本研究旨在总结各国住院 HF 患者的 30 天和 1 年全因再入院和死亡率，并探讨全球范围内这些比率的潜在差异。
我们使用 MEDLINE、Embase 和 CENTRAL 进行了系统评价和荟萃分析，以获取 2010 年 1 月至 2021 年 3 月期间发表的关于有再入院或死亡风险的住院成年 HF 患者的观察性报告。我们使用随机效应模型对比例进行荟萃分析，并通过荟萃回归评估异质性来源。
共纳入 24 篇报告 30 天再入院率的论文和 23 篇报告 1 年再入院率的论文。在有风险的 150 万人中，30 天内再入院率为 13.2%（95%CI：10.5%-16.1%），1 年内再入院率为 35.7%（95%CI：27.1%-44.9%）。共有 33 篇论文报告了 30 天死亡率，45 篇论文报告了 1 年死亡率。在因 HF 住院的 150 万人中，30 天内死亡率为 7.6%（95%CI：6.1%-9.3%），1 年内死亡率为 23.3%（95%CI：20.8%-25.9%）。各国的国内生产总值、用于医疗保健的国内生产总值比例和基尼系数并不能解释风险在国家间的巨大差异。
全球范围内，住院 HF 患者再入院和死亡率较高，再入院率的差异不能用医疗保健支出、死亡率风险或合并症来解释。
