Division of Cardiology, Weill Cornell Medical College, New York, New York.
Department of Health Policy and Management, George Washington University, Washington, DC.
JAMA Netw Open. 2024 Aug 1;7(8):e2428964. doi: 10.1001/jamanetworkopen.2024.28964.
Despite advances in treatment and care quality for patients hospitalized with heart failure (HF), minimal improvement in mortality has been observed after HF hospitalization since 2010.
To evaluate trends in mortality rates across specific intervals after hospitalization.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated a random sample of Medicare fee-for-service beneficiaries with incident HF hospitalization from January 1, 2008, to December 31, 2018. Data were analyzed from February 2023 to May 2024.
Unadjusted mortality rates were calculated by dividing the number of all-cause deaths by the number of patients with incident HF hospitalization for the following periods: in-hospital, 30 days (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1-2 years after discharge), and long term (2-3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Annual unadjusted and risk-adjusted mortality ratios were calculated (using logistic regression to account for differences in patient characteristics), defined as observed mortality divided by expected mortality based on 2008 rates.
A total of 1 256 041 patients (mean [SD] age, 83.0 [7.6] years; 56.0% female; 86.0% White) were hospitalized with incident HF. There was a substantial decrease in the mortality ratio for the in-hospital period (unadjusted ratio, 0.77; 95% CI, 0.67-0.77; risk-adjusted ratio, 0.74; 95% CI, 0.71-0.76). For subsequent periods, mortality ratios increased through 2013 and then decreased through 2018, resulting in no reductions in unadjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.94; 95% CI, 0.82-1.06; short-term mortality ratio, 1.02; 95% CI, 0.87-1.17; intermediate-term mortality ratio, 0.99; 95% CI, 0.79-1.19; and long-term mortality ratio, 0.96; 95% CI, 0.76-1.16) and small reductions in risk-adjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.88; 95% CI, 0.86-0.90; short-term mortality ratio, 0.94; 95% CI, 0.94-0.95; intermediate-term mortality ratio, 0.94; 95% CI, 0.92-0.95; and long-term mortality ratio, 0.95; 95% CI, 0.93-0.96).
In this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.
尽管在治疗和心力衰竭（HF）患者护理质量方面取得了进展，但自 2010 年以来，HF 住院患者的死亡率几乎没有改善。
评估住院后特定时间段死亡率的趋势。
设计、地点和参与者：这项队列研究评估了 2008 年 1 月 1 日至 2018 年 12 月 31 日期间因 HF 住院的 Medicare 按服务收费受益人的随机样本。数据于 2023 年 2 月至 2024 年 5 月进行分析。
通过将所有因心力衰竭住院患者的死亡人数除以因心力衰竭住院的患者人数来计算未调整的死亡率，以下是以下各时间段的死亡率：住院期间、30 天（出院后 0-30 天）、短期（出院后 31 天至 1 年）、中期（出院后 1-2 年）和长期（出院后 2-3 年）。每个时期都分别考虑（即，在一个时期内死亡的患者不计入随后的时期）。每年计算未调整和风险调整后的死亡率比（使用逻辑回归来考虑患者特征的差异），定义为观察到的死亡率除以基于 2008 年死亡率的预期死亡率。
共有 1256041 名患者（平均[SD]年龄 83.0[7.6]岁；56.0%为女性；86.0%为白人）因心力衰竭住院。住院期间的死亡率比大幅下降（未调整比值为 0.77；95%CI，0.67-0.77；风险调整比值为 0.74；95%CI，0.71-0.76）。对于随后的时期，死亡率比值在 2013 年之前增加，然后在 2018 年之前减少，导致整个研究期间未调整的出院后死亡率没有降低（30 天死亡率比值为 0.94；95%CI，0.82-1.06；短期死亡率比值为 1.02；95%CI，0.87-1.17；中期死亡率比值为 0.99；95%CI，0.79-1.19；长期死亡率比值为 0.96；95%CI，0.76-1.16），整个研究期间风险调整后出院后死亡率略有降低（30 天死亡率比值为 0.88；95%CI，0.86-0.90；短期死亡率比值为 0.94；95%CI，0.94-0.95；中期死亡率比值为 0.94；95%CI，0.92-0.95；长期死亡率比值为 0.95；95%CI，0.93-0.96）。
在这项对 Medicare 按服务收费受益人的研究中，因心力衰竭住院的患者的住院期间死亡率从 2008 年到 2018 年大幅下降，但随后的时期内死亡率几乎没有下降，直到出院后 3 年。这些结果表明有机会改善心力衰竭患者出院后的纵向门诊护理。
