The Alfred Hospital, Melbourne, Vic, Australia.
Deakin University, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2024 Jul;33(7):983-989. doi: 10.1016/j.hlc.2024.01.016. Epub 2024 Mar 7.
Acute decompensated heart failure (ADHF) is a leading cause of cardiovascular disease hospitalisations associated with significant morbidity and mortality. In hospitals, HF patients are typically managed by cardiology or physician teams, with differences in patient demographics and clinical outcomes. This study utilises contemporary HF registry data to compare patient characteristics and outcomes in those with ADHF admitted into General Medicine and Cardiology units.
The Victorian Cardiac Outcomes Registry was utilised to identify patients hospitalised with ADHF 30-day period in each of four consecutive years. We compared patient characteristics, pharmacological management and outpatient follow-up of patients admitted to General Medicine and Cardiology units. Primary outcome measures included in-hospital mortality, 30-day readmission, and 30-day mortality.
Between 2014 and 2017, a total of 1,253 patients with ADHF admissions were registered, with 53% admitted in General Medicine units and 47% in Cardiology units. General Medicine patients were more likely to be older (82 vs 71 years; p<0.001), female (51% vs 34%; p<0.001), and have higher prevalence of comorbidities and preserved left ventricular function (p<0.001). There were no differences in primary outcome measures between General Medicine and Cardiology in terms of: in-hospital mortality (5.0% vs 3.9%; p=0.35), 30-day readmission (23.4% vs 23.6%; p=0.93), and 30-day mortality (10.0% vs 8.0%; p=0.21).
Hospitalised patients with HF continue to have high mortality and rehospitalisation rates. The choice of treatment by General Medicine or Cardiology units, based on the particular medical profile and individual needs of the patients, provides equivalent outcomes.
急性失代偿性心力衰竭（ADHF）是心血管疾病住院的主要原因，与较高的发病率和死亡率相关。在医院中，HF 患者通常由心脏病学或内科医生团队进行管理，患者的人口统计学特征和临床结局存在差异。本研究利用当代 HF 登记数据比较了 ADHF 患者入住普通内科和心脏病科的患者特征和结局。
利用维多利亚心脏结局登记处（Victorian Cardiac Outcomes Registry），确定在连续四年的每个 30 天时间段内因 ADHF 住院的患者。我们比较了入住普通内科和心脏病科的患者的特征、药物治疗和门诊随访。主要结局指标包括住院死亡率、30 天再入院率和 30 天死亡率。
2014 年至 2017 年间，共有 1253 例 ADHF 住院患者被登记，其中 53%入住普通内科，47%入住心脏病科。普通内科患者年龄更大（82 岁 vs 71 岁；p<0.001）、女性比例更高（51% vs 34%；p<0.001）、合并症和左心室功能保留的患病率更高（p<0.001）。在住院死亡率（5.0% vs 3.9%；p=0.35）、30 天再入院率（23.4% vs 23.6%；p=0.93）和 30 天死亡率（10.0% vs 8.0%；p=0.21）方面，普通内科和心脏病科之间没有差异。
住院 HF 患者的死亡率和再入院率仍然很高。普通内科或心脏病科根据患者的特定医疗状况和个体需求选择治疗，可提供等效的结局。
