Zilberberg Marya D, Nathanson Brian H, Sulham Kate, Mohr John F, Goodwin Matthew, Shorr Andrew F
EviMed Research Group, LLC, Goshen, MA, USA.
OptiStatim, LLC, Longmeadow, MA, USA.
Clinicoecon Outcomes Res. 2023 Sep 29;15:721-731. doi: 10.2147/CEOR.S423868. eCollection 2023.
Two-thirds of the 1 million annual US CHF hospitalizations are for diuresis only; some may be avoidable. We describe a population of low-severity short-stay (</= 4 days) patients admitted for CHF.
We conducted a retrospective cohort study within the Premier Healthcare Database, 2016-2021. CHF was defined via an administrative code algorithm. High severity (CHF-H) was marked by cardiogenic shock, the need for respiratory or circulatory support, and/or a Charlson comorbidity index >2. We compared baseline characteristics, processes of care, and outcomes in low-severity (CHF-L) to CHF-H.
Among 301,672 short-stay CHF patients, 135,304 (44.8%) were CHF-L. Compared to CHF-H, CHF-L was younger (70.5 ± 14.1 vs 72.1 ± 13.6 years, p < 0.001), more commonly female (48.6% vs 45.8%, p < 0.001), and more likely to receive IV ACE-I/ARB agents (0.5% vs 0.4%, p = 0.003). Most other IV medications were more common in CHF-H, and anticoagulation was the most prevalent non-diuretic IV therapy in both groups (23.8% vs 33.3%, p < 0.001). Hospital mortality (0.2% vs 1.5%, p < 0.001) and CHF-related 30-day readmissions (8.1% vs 10.5%, p < 0.001) were lower in CHF-L than CHF-H.
Among short-stay CHF patients, nearly ½ meet criteria for CHF-L, and are mainly admitted for fluid management. Avoiding these admissions could result in substantial savings.
美国每年100万例慢性心力衰竭（CHF）住院病例中，三分之二仅为利尿治疗；其中一些可能是可以避免的。我们描述了一组因CHF入院的低严重程度短期住院（≤4天）患者。
我们在2016 - 2021年的Premier医疗数据库中进行了一项回顾性队列研究。CHF通过行政代码算法定义。高严重程度（CHF - H）以心源性休克、呼吸或循环支持需求以及/或Charlson合并症指数>2为特征。我们比较了低严重程度（CHF - L）与CHF - H患者的基线特征、护理过程和结局。
在301,672例短期住院的CHF患者中，135,304例（44.8%）为CHF - L。与CHF - H相比，CHF - L患者更年轻（70.5±14.1岁 vs 72.1±13.6岁，p<0.001），女性更常见（48.6% vs 45.8%，p<0.001），且更可能接受静脉注射ACE - I/ARB药物（0.5% vs 0.4%，p = 0.003）。大多数其他静脉药物在CHF - H中更常见，抗凝是两组中最普遍的非利尿静脉治疗（23.8% vs 33.3%，p<0.001）。CHF - L患者的医院死亡率（0.2% vs 1.5%，p<0.001）和与CHF相关的30天再入院率（8.1% vs 10.5%，p<0.001）低于CHF - H。
在短期住院的CHF患者中，近一半符合CHF - L标准，且主要因液体管理入院。避免这些入院可能会节省大量费用。
