Soloveva A E, Gorbacheva T V, Solovev A E, Villevalde S V, Zvartau N E, Shlyakhto E V
Almazov National Medical Research Centre.
St. Petersburg Medical Information and Analytical Center.
Kardiologiia. 2024 Nov 30;64(11):96-105. doi: 10.18087/cardio.2024.11.n2781.
Aim To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P<0.001 was considered significant.Results The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p<0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.
评估心力衰竭（HF）患者出院后一年内再住院的累积发生率及其预后价值。
从圣彼得堡慢性心力衰竭登记处选取2022年1月1日至2024年2月13日期间首次因HF住院（诊断代码为I50.x）的患者数据。分析年龄和性别特征、合并症、出院后再住院和死亡风险与再住院次数的关系。采用描述性统计方法、Kaplan-Meier生存分析和Fine and Gray竞争风险模型。P<0.001被认为具有统计学意义。
该研究纳入了43143例首次因HF住院的患者。在中位观察时间242天内，6395例（14.8%）患者再次入院，其中大多数为1次（78.4%）。男性、缺血性HF患者、心房颤动患者、糖尿病患者、阻塞性肺疾病患者以及有COVID-19病史的患者再住院次数较多。考虑到死亡的竞争风险，HF患者在1、3、6和12个月时的再住院累积发生率分别为3.2%、7.0%、10.8%和17.2%。随着住院次数的增加，下次住院的中位时间缩短，再入院风险增加（P<0.001）。首次住院后一年内的死亡概率为14.9%（95%置信区间[CI]：14.5%-15.3%）。无再入院患者的全因死亡率为每100患者年19例，而再入院1次、2次和至少3次的患者全因死亡率分别为每100患者年30例、44例和54例。再入院患者的死亡风险增加：再入院1次、2次和至少3次的患者调整后的死亡风险比分别为1.47（95%CI：1.36-1.59）、1.97（95%CI：1.69-2.30）和2.24（95%CI：1.81-2.78）。
首次因HF住院的患者，经死亡竞争风险调整后的一年HF再住院累积发生率为17.2%。再入院率增加与再入院和死亡几率增加独立相关。
