Ayenew Birhanu, Kumar Prem, Hussein Adem, Gashaw Yegoraw, Girma Mitaw, Ayalew Abdulmelik, Tadesse Beza
Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
J Pharm Health Care Sci. 2023 Nov 27;9(1):49. doi: 10.1186/s40780-023-00320-y.
Drug therapy is a crucial aspect of heart failure management and has been shown to reduce morbidity and mortality in heart failure patients. However, the comparative effects of these drug classes on readmission rates have not been well studied. Therefore, the aim of this study was to examine the association between different classes of heart failure drugs and 30-day readmission rates in patients with heart failure.
A multicenter, hospital-based retrospective cohort design was employed and 572 randomly selected patients with heart failure were included. Data were entered in Epi-data version 4.6 and analyzed with STATA version 17. Kaplan-Meier and log-rank tests were used to estimate and compare survival time. A Cox proportional hazard model was utilized, employing both bi-variable and multi-variable analyses, to examine the effect of predictors on the timing of unplanned hospital readmissions. The strength of the association was assessed using an adjusted hazard ratio (aHR), and statistical significance was declared for p-values < 0.05 and a 95% confidence interval (CI).
In this study, a total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. In the multivariate cox proportional hazards analysis being an age (> 65 year) (AHR: 2.34, 95%CI: 1.63, 3.37), rural in residency (AHR: 1.85, 95%CI: 1.07, 3.20), hospital stays > 7 Days (AHR: 3.68, 95%CI: 2.51,5.39), discharge with Diuretics (AHR: 2.37, 95%CI: 1.45, 3.86), and discharge with Beta-Blocker (AHR: 0.48, 95%CI: 0 0.34, 0.69) were identified as independent predictors of unplanned hospital readmission.
Elderly patients, being in rural areas, longer hospital stays, and discharges of patients on diuretics and not on beta-blockers were independent predictors of unplanned hospital readmission. Therefore, working on these factors will help to reduce the hazard of unplanned hospital readmissions, improve patient outcomes, and increase the efficiency of heart failure management.
药物治疗是心力衰竭管理的关键环节，已证明可降低心力衰竭患者的发病率和死亡率。然而，这些药物类别对再入院率的比较效果尚未得到充分研究。因此，本研究的目的是探讨不同类别的心力衰竭药物与心力衰竭患者30天再入院率之间的关联。
采用多中心、基于医院的回顾性队列设计，纳入572例随机选择的心力衰竭患者。数据录入Epi-data 4.6版本，并使用STATA 17版本进行分析。采用Kaplan-Meier法和对数秩检验来估计和比较生存时间。使用Cox比例风险模型，采用双变量和多变量分析，以检验预测因素对非计划住院再入院时间的影响。使用调整后的风险比（aHR）评估关联强度，p值<0.05和95%置信区间（CI）具有统计学意义。
在本研究中，共有151例（26.40%）心力衰竭患者在出院后30天内再次入院。在多变量Cox比例风险分析中，年龄>65岁（aHR：2.34，95%CI：1.63，3.37）、居住在农村（aHR：1.85，95%CI：1.07，3.20）、住院时间>7天（aHR：3.68，95%CI：2.51，5.39）、出院时使用利尿剂（aHR：2.37，95%CI：1.45，3.86）以及出院时使用β受体阻滞剂（aHR：0.48，95%CI：0.34，0.69）被确定为非计划住院再入院的独立预测因素。
老年患者、农村地区患者、住院时间较长以及出院时使用利尿剂而非β受体阻滞剂的患者是非计划住院再入院的独立预测因素。因此，针对这些因素采取措施将有助于降低非计划住院再入院的风险，改善患者预后，并提高心力衰竭管理的效率。
