Lowe J M, Candlish P M, Henry D A, Wlodarcyk J H, Heller R F, Fletcher P J
Department of General Medicine, John Hunter Hospital, Newcastle, NSW.
Med J Aust. 1998 Feb 2;168(3):115-8. doi: 10.5694/j.1326-5377.1998.tb126744.x.
To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF).
Prospective cohort study with one-year follow-up.
409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993.
John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non-tertiary referral for cardiology), Newcastle, New South Wales.
Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis.
Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100,000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28-day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one-year mortality. Greater comorbidity was associated significantly with longer LOS and non-significantly with higher 28-day and one-year mortality.
CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.
描述充血性心力衰竭（CHF）住院患者的发病率、死亡率及护理模式。
为期一年随访的前瞻性队列研究。
1993年5月1日至11月30日期间因充血性心力衰竭入住医院的409例60岁及以上患者。
新南威尔士州纽卡斯尔的约翰·亨特医院（心脏病学三级转诊医院）和 Mater 医院（心脏病学非三级转诊医院）。
住院时间（LOS）；非计划再入院；28天和一年时的死亡率；以及通过多变量分析确定的结局与患者及疾病特征之间的关系。
60岁及以上年龄组CHF的年住院率为783/100,000，CHF占该年龄组患者的10.9%。中位住院时间为8天，不同医院之间差异显著。出院时66%的受试者正在服用ACE抑制剂。28天内非计划再入院率为20%。28天时死亡率为12.5%，一年时为33%。对于首次因CHF入院，28天死亡率低于再入院（优势比，0.25；95%置信区间，0.1 - 0.62），平均住院时间短17%。年龄增加和肾功能损害与一年时较高的死亡率显著相关。合并症越多与住院时间越长显著相关，与28天和一年时较高的死亡率无显著相关。
CHF是入院的常见原因，常导致非计划再入院，且死亡率高。ACE抑制剂治疗不足的情况仍然存在。避免再次入院的重要性显而易见。强化病例管理计划可能减轻CHF所致负担。
