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心力衰竭患者多学科护理的益处是否存在性别差异?UMIPIC项目的结果。

Are There Gender Differences in the Benefits of Multidisciplinary Care in Patients with Heart Failure? Results from the UMIPIC Program.

作者信息

Conde-Martel Alicia, Méndez-Bailón Manuel, Montero-Pérez-Barquero Manuel, González-Franco Álvaro, Cerqueiro José Manuel, Pérez-Silvestre José, Fernández-Rodríguez José María, Llàcer Pau, Casado Jesús, Formiga Francesc, Salamanca-Bautista Prado, Arévalo-Lorido Jose Carlos, Manzano Luis

机构信息

Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, 35010 Las Palmas, Spain.

Health Sciences Faculty, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.

出版信息

J Clin Med. 2025 Aug 17;14(16):5818. doi: 10.3390/jcm14165818.

Abstract

: Heart failure (HF) is a leading cause of hospitalization in older adults, with significant sex differences in presentation, treatment, and outcomes. Transitional care models may benefit women more, yet they often receive less follow-up. This study assessed whether the clinical impact of the UMIPIC multidisciplinary HF management program differs by sex. This prospective, multicenter, observational cohort study included HF patients enrolled in the UMIPIC program or followed through conventional care in the RICA registry. Outcomes (30-day and one-year mortality and readmissions) were compared between groups, stratified by sex. Multivariate Cox models adjusted for age, HF phenotype, comorbidities, and baseline therapy. A total of 5644 HF patients were included, with 2034 (36%) managed in UMIPIC and 3610 (64%) receiving conventional care. Women represented 55% of UMIPIC patients and were older, with higher prevalence of hypertension, anemia, and HF with preserved ejection fraction (HFpEF) compared to conventional care. At 30 days, women in UMIPIC had lower all-cause mortality (4.0% vs. 8.0%), cardiovascular mortality (2.0% vs. 6.0%), and readmissions (9.0% vs. 18.0%; all < 0.01); these benefits persisted at one year. In multivariate analysis, UMIPIC enrollment remained protective (HR: 0.79; 95% CI: 0.71-0.87; < 0.001). In men, UMIPIC patients were older with more comorbidities and higher HFpEF prevalence. They also showed lower 30-day mortality (2.0% vs. 8.0%; < 0.05) and readmissions (8.0% vs. 18.0%; < 0.01), with benefits maintained at one year. UMIPIC enrollment remained independently associated with reduced one-year mortality in men (HR: 0.79; 95% CI: 0.71-0.88; < 0.001). The UMIPIC multidisciplinary care model reduced one-year mortality and readmissions in both women and men with HF, supporting integrated care strategies to improve outcomes in this high-risk population.

摘要

心力衰竭(HF)是老年人住院治疗的主要原因,在症状表现、治疗和预后方面存在显著的性别差异。过渡性护理模式可能对女性更有益,但她们往往接受的随访较少。本研究评估了UMIPIC多学科HF管理项目的临床影响是否因性别而异。这项前瞻性、多中心、观察性队列研究纳入了参加UMIPIC项目或在RICA登记处接受常规护理的HF患者。按性别分层,比较了两组之间的结局(30天和一年死亡率及再入院率)。多变量Cox模型对年龄、HF表型、合并症和基线治疗进行了调整。共纳入5644例HF患者,其中2034例(36%)接受UMIPIC管理,3610例(64%)接受常规护理。女性占UMIPIC患者的55%,年龄更大,与常规护理相比,高血压、贫血和射血分数保留的心力衰竭(HFpEF)患病率更高。在30天时,UMIPIC组的女性全因死亡率(4.0%对8.0%)、心血管死亡率(2.0%对6.0%)和再入院率(9.0%对18.0%;均P<0.01)较低;这些益处持续到一年。在多变量分析中,参加UMIPIC项目仍然具有保护作用(风险比:0.79;95%置信区间:0.71-0.87;P<0.001)。在男性中,UMIPIC组的患者年龄更大,合并症更多,HFpEF患病率更高。他们在30天时的死亡率(2.0%对8.0%;P<0.05)和再入院率(8.0%对18.0%;P<0.01)也较低,益处持续到一年。参加UMIPIC项目仍然与男性一年死亡率降低独立相关(风险比:0.79;95%置信区间:0.71-0.88;P<0.001)。UMIPIC多学科护理模式降低了HF女性和男性的一年死亡率和再入院率,支持综合护理策略以改善这一高危人群的结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c266/12387713/b6cb47f919ee/jcm-14-05818-g001.jpg

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