心力衰竭住院患者的家庭时间、死亡率和再入院情况：在实施心力衰竭（IMPLEMENT-HF）之前的基线情况。
Home-Time, Mortality, and Readmissions Among Patients Hospitalized With Heart Failure: A Baseline Prior to IMPLEMENT-HF.
机构信息
Department of Medicine, University of California Los Angeles (A.B.T.).
Duke Clinical Research Institute, Durham, NC (N.S., K.C., S.J.G.).
出版信息
Circ Heart Fail. 2024 Oct;17(10):e011795. doi: 10.1161/CIRCHEARTFAILURE.124.011795. Epub 2024 Oct 9.
BACKGROUND
Home-time is an emerging, patient-centered outcome that represents the amount of time a patient spends alive and outside of health care facility settings, comprising of hospitals, skilled nursing facilities, and acute rehabilitation centers. Studies evaluating home-time in the context of heart failure are limited, and the impact of quality improvement interventions on home-time has not been studied.
METHODS
Medicare beneficiaries aged 65 years or older who were hospitalized for heart failure in the Get With the Guidelines-Heart Failure registry between 2019 and 2021 were included. Postdischarge home-time, mortality, and readmission rates at 30 days and 1 year were calculated with the goal of establishing baseline metrics before the initiation of IMPLEMENT-HF, a multicenter quality improvement program aimed at improving heart failure management.
RESULTS
Overall, 66 019 patients were included across 437 sites. Median 30-day and 1-year home-time were 30 (18-30) and 333 (139-362) days, respectively. Only 22.1% of patients experienced 100% home-time in the year after discharge. Older patients spent significantly less time at home, with a median 1-year home-time of 302 (86-359) compared with 345 (211-365) days in patients over 85 and those between 65 and 74 years old, respectively (<0.001). Black patients also experienced the least amount of home-time with only 328 (151-360) days at 1-year follow-up. Rates of heart failure readmission and all-cause mortality 1-year post-discharge were high at 29.8% and 37.0%, respectively.
CONCLUSIONS
In this contemporary multicenter cohort, patients hospitalized with heart failure spent a median of 91.2% of their time in the year after discharge alive and at home, largely driven by high mortality rates. These findings serve as a preimplementation baseline for IMPLEMENT-HF, which will evaluate the impact of targeted heart failure initiatives on home-time and other clinical outcomes.
背景
居家时间是一个新兴的以患者为中心的结果指标，代表患者在医疗机构（包括医院、护理院和急性康复中心）外存活并度过的时间。目前评估心力衰竭患者居家时间的研究有限，且尚未研究质量改进干预措施对居家时间的影响。
方法
本研究纳入了 2019 年至 2021 年期间在 Get With the Guidelines-Heart Failure 注册研究中因心力衰竭住院的年龄在 65 岁及以上的 Medicare 受益患者。计算了出院后 30 天和 1 年的居家时间、死亡率和再入院率，目的是在启动多中心质量改进项目（旨在改善心力衰竭管理）IMPLEMENT-HF 之前建立基线指标。
结果
共有 437 个中心的 66019 例患者纳入研究。30 天和 1 年的中位居家时间分别为 30（18-30）和 333（139-362）天。仅有 22.1%的患者在出院后 1 年内完全居家。年龄较大的患者居家时间明显较短，85 岁以上患者的中位 1 年居家时间为 302（86-359）天，65-74 岁患者的中位居家时间为 345（211-365）天（<0.001）。黑人患者的居家时间也最短，1 年随访时仅为 328（151-360）天。出院后 1 年心力衰竭再入院和全因死亡率分别高达 29.8%和 37.0%。
结论
在这项当代多中心队列研究中，因心力衰竭住院的患者在出院后 1 年内中位有 91.2%的时间存活且居家，主要是由于高死亡率所致。这些发现为 IMPLEMENT-HF 提供了实施前的基线数据，该项目将评估针对心力衰竭的特定干预措施对居家时间和其他临床结局的影响。
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