Bilora F, Vettore G, Saccaro G, Barbata A, Dei Rossi C, Petrobelli F
Università degli Studi, Padova II Clinica Medica.
Minerva Cardioangiol. 1998 Jul-Aug;46(7-8):235-9.
Heart failure is a frequent pathology that requires a high degree of hospitalization. These characteristics have a high assistance cost. The purpose of this study was to evaluate the prevalence, acuteness, predisposing factors and therapy carried out in patients of a northeastern Italian town, and to evaluate their impact on health costs.
We have examined patient under observation of the Department of Emergency at the Padua Hospital for 12 months. They had been hospitalized for heart failure symptoms. They all underwent individual and pharmacological anamnesis, objective exam, ECG, thorax X-rays and echocardiogram. The health expenses were calculated in relation to hospital stay, the cost of daily assistance, exams and medical treatments used.
630 patients of both sexes (422 males and 208 females) aged 74.6 +/- 6.1 were studied. Among significantly interrelated factors were: hypertension in 51.4% of the patients; diabetes mellitus in 9% of the patients; hypercholesterolemia in 31.3% of the patients; hypertriglyceridemia in 7.2% of the patients; cigarettes smoking in 19.3% of the patients, whereas obesity was present in 19.7% of all the subjects. Heart diseases directly correlated with heart failure were respectively: myocardial ischemia (65.6%); hypertensive cardiopathy (14.7%); idiopathic dilatative (15%); and valvular cardiopathy (4.7%). In 9.5% of cases, patients presented episodes of TIA, ictus, or they were carriers of neurologic focal deficiencies. As far as NYHA functional class was concerned, the third was most prevalent with a different distribution (p < 0.05) between males and females. ACE inhibitors, digitalis and calcium antagonists are to be indicated among the most widely used drugs. The health cost for patients in this survey was deduced on the basis of: average; hospitalization stay (9.8 days); estimated daily expenses for patient and for further controls (L. 282,000); the area of users (85% of residents). Therefore the full hospital assistance of patients with heart failure is approximately L. 2.1 thousand millions.
Given the high preponderance of heart failure, the frequent relation with vascular risk factors and with ischemic cardiopathy, further investigation is necessary to curb these high rates. On the other hand, the NYHA advanced state of patients is not likely to allow lower costs in relation to hospital admission or the reduction of hospital stay. Nevertheless, the individualization of standardized therapeutic protocols and an adequate home care surveillance follow-up may reduce the number of hospitalizations and consequently the connected health expenses.
心力衰竭是一种常见病症，需要高度住院治疗。这些特征导致高昂的医疗成本。本研究旨在评估意大利东北部一个城镇患者的患病率、急性程度、诱发因素及所接受的治疗，并评估其对医疗费用的影响。
我们对帕多瓦医院急诊科观察的患者进行了为期12个月的检查。他们因心力衰竭症状住院。所有患者均接受了个人和用药问诊、体格检查、心电图、胸部X光和超声心动图检查。根据住院时间、日常护理费用、检查和所用药物治疗计算医疗费用。
研究了630名男女患者（男性422名，女性208名），年龄74.6±6.1岁。显著相关的因素包括：51.4%的患者患有高血压；9%的患者患有糖尿病；31.3%的患者患有高胆固醇血症；7.2%的患者患有高甘油三酯血症；19.3%的患者吸烟，而19.7%的所有受试者存在肥胖。与心力衰竭直接相关的心脏病分别为：心肌缺血（65.6%）；高血压性心脏病（14.7%）；特发性扩张型心肌病（15%）；瓣膜性心脏病（4.7%）。在9.5%的病例中，患者出现短暂性脑缺血发作、卒中或存在神经局灶性缺陷。就纽约心脏病协会（NYHA）心功能分级而言，Ⅲ级最为常见，男女分布不同（p<0.05）。血管紧张素转换酶（ACE）抑制剂、洋地黄和钙拮抗剂是使用最广泛的药物。本次调查患者的医疗费用是根据以下因素推算的：平均住院时间（9.8天）；患者及进一步检查的估计每日费用（28.2万意大利里拉）；使用者区域（居民的85%）。因此，心力衰竭患者的全部住院护理费用约为21亿意大利里拉。
鉴于心力衰竭的高占比、与血管危险因素和缺血性心脏病的频繁关联，有必要进一步研究以控制这些高发病率。另一方面，患者的NYHA心功能分级处于晚期，不太可能降低住院相关成本或缩短住院时间。然而，标准化治疗方案的个体化和充分的家庭护理监测随访可能会减少住院次数，从而降低相关医疗费用。
