Krumholz H M, Parent E M, Tu N, Vaccarino V, Wang Y, Radford M J, Hennen J
Department of Medicine, Yale School of Medicine, New Haven, Conn, USA.
Arch Intern Med. 1997 Jan 13;157(1):99-104.
Congestive heart failure is the most common discharge diagnosis for Medicare beneficiaries. While several single-center studies have suggested that these patients are particularly vulnerable to readmission, no recent study, to our knowledge, has reported the readmission rates for a large number of elderly patients with congestive heart failure across a diverse spectrum of hospitals.
To define the readmission rate for elderly patients discharged after an episode of congestive heart failure. To determine the spectrum of diagnoses that are responsible for readmissions among patients with congestive heart failure. To identify patient and hospital characteristics associated with a higher likelihood of readmission.
This observational study, using Medicare administrative files, evaluated readmission and death among all survivors of a hospitalization in Connecticut for congestive heart failure from fiscal year 1991 through fiscal year 1994.
There were 17448 survivors of a hospitalization for congestive heart failure during the study period. In the 6 months following the index admission, 7596 patients (44%) were readmitted to a hospital at least once. Congestive heart failure was the most frequent reason for readmission among study patients, accounting for 18% of all readmissions. In the multivariable analysis, significant predictors of readmission included male sex (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.05-1.20), at least 1 prior admission within 6 months of the index admission (OR, 1.64; 95% CI, 1.53-1.77), Deyo comorbidity score of more than 1 (OR, 1.56; 95% CI, 1.45-1.68), and length of stay in the index hospitalization of more than 7 days (OR, 1.32; 95% CI, 1.24-1.41). While age was not a significant predictor of readmission, it became significant in a model with the combined outcome of readmission or death as the dependent variable.
Readmission after a hospitalization for congestive heart failure is common among Medicare beneficiaries, with almost half of the patients readmitted within 6 months. This striking rate of readmission in a common diagnosis demands efforts to further clarify the determinants of readmission and develop strategies to prevent this adverse outcome.
充血性心力衰竭是医疗保险受益人的最常见出院诊断。虽然几项单中心研究表明这些患者特别容易再次入院，但据我们所知，最近没有研究报告过大量不同医院的老年充血性心力衰竭患者的再入院率。
确定充血性心力衰竭发作后出院的老年患者的再入院率。确定导致充血性心力衰竭患者再次入院的诊断范围。识别与再入院可能性较高相关的患者和医院特征。
这项观察性研究使用医疗保险行政档案，评估了1991财年至1994财年康涅狄格州因充血性心力衰竭住院的所有幸存者的再入院情况和死亡情况。
在研究期间，有17448名充血性心力衰竭住院幸存者。在首次入院后的6个月内，7596名患者（44%）至少再次入院一次。充血性心力衰竭是研究患者再次入院的最常见原因，占所有再入院的18%。在多变量分析中,再入院的显著预测因素包括男性(比值比[OR]，1.12；95%置信区间[CI]，1.05 - 1.20)、在首次入院前6个月内至少有1次先前入院(OR，1.64；95% CI，1.53 - 1.77)、Deyo合并症评分大于1(OR，1.56；95% CI，1.45 - 1.68)以及首次住院时间超过7天(OR，1.32；95% CI，1.24 - 1.41)。虽然年龄不是再入院的显著预测因素，但在以再入院或死亡的联合结果作为因变量的模型中，年龄变得显著。
充血性心力衰竭住院后的再入院在医疗保险受益人中很常见，近一半的患者在6个月内再次入院。在常见诊断中如此高的再入院率需要努力进一步阐明再入院的决定因素并制定预防这一不良后果的策略。
