Stewart S, Vandenbroek A J, Pearson S, Horowitz J D
Cardiology Unit, Queen Elizabeth Hospital/University of Adelaide, Woodville, South Australia.
Arch Intern Med. 1999 Feb 8;159(3):257-61. doi: 10.1001/archinte.159.3.257.
A single home-based intervention (HBI) applied immediately after hospital discharge in a cohort of "high-risk" patients with congestive heart failure has been shown to decrease numbers of unplanned readmissions plus out-of-hospital deaths during a period of 6 months. The duration of this beneficial effect remains uncertain.
Hospitalized patients with congestive heart failure who had been randomly assigned to receive either usual care (n=48) or HBI 1 week after discharge (n=49) were subject to an extended follow-up of 18 months. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths. Secondary end points included total hospital stay, frequency of multiple readmissions, cost of hospital-based care, and total mortality.
During 18-month follow-up, HBI patients had fewer unplanned readmissions (64 vs 125; P=.02) and out-of-hospital deaths (2 vs 9; P=.02), representing 1.4+/-1.3 vs 2.7+/-2.8 events per HBI and usual-care patient, respectively (P=.03). The HBI patients also had fewer days of hospitalization (2.5+/-2.7 vs 4.5+/-4.8 per patient; P=.004) and, once readmitted, were less likely to experience 4 or more readmissions (3/31 vs 12/38; P=.03). Hospital-based costs were significantly lower among HBI patients (Aust $5100 vs Aust $10600 per patient; P=.02). Unplanned readmission was positively correlated with 14 days or more of unplanned readmission in the 6 months before study entry (odds ratio [OR], 5.4; P=.006). Positive correlates of death were (1) non-English speaking (OR, 4.9; P=.008), (2) 14 days or more of unplanned readmission in the 6 months before study entry (OR, 4.9; P=.008), and (3) left ventricular ejection fraction of 40% or less (OR, 3.0; P=.03); conversely, assignment to HBI was a negative correlate (OR, 0.3; P=.02).
In this controlled study, among a cohort of high-risk patients with congestive heart failure, beneficial effects of a postdischarge HBI were sustained for at least 18 months, with a significant reduction in unplanned readmissions, total hospital stay, hospital-based costs, and mortality.
在一组“高危”充血性心力衰竭患者出院后立即实施单一的家庭干预（HBI），已被证明可在6个月内减少非计划再入院次数及院外死亡人数。这种有益效果的持续时间仍不确定。
将住院的充血性心力衰竭患者随机分为两组，一组接受常规护理（n = 48），另一组在出院1周后接受家庭干预（HBI，n = 49），并对其进行为期18个月的延长随访。该研究的主要终点是非计划再入院次数及院外死亡频率。次要终点包括总住院时间、多次再入院频率、住院治疗费用及总死亡率。
在18个月的随访期间，接受家庭干预（HBI）的患者非计划再入院次数（64次对125次；P = 0.02）和院外死亡人数（2例对9例；P = 0.02）较少，分别相当于每位接受家庭干预（HBI）和常规护理的患者发生1.4±1.3次和2.7±2.8次事件（P = 0.03）。接受家庭干预（HBI）的患者住院天数也较少（每位患者2.5±2.7天对4.5±4.8天；P = 0.004），并且一旦再次入院，发生4次或更多次再入院的可能性较小（3/31对12/38；P = 0.03）。家庭干预（HBI）患者的住院费用显著较低（每位患者5100澳元对10600澳元；P = 0.02）。非计划再入院与研究入组前6个月内14天或更长时间的非计划再入院呈正相关（优势比[OR]，5.4；P = 0.006）。死亡的正相关因素为：（1）非英语母语（OR，4.9；P = 0.008），（2）研究入组前6个月内14天或更长时间的非计划再入院（OR，4.9；P = 0.008），以及（3）左心室射血分数40%或更低（OR，3.0；P = 0.03）；相反，被分配到家庭干预（HBI）组是一个负相关因素（OR，0.3；P = 0.02）。
在这项对照研究中，在一组高危充血性心力衰竭患者中，出院后家庭干预（HBI）的有益效果持续了至少18个月，非计划再入院次数、总住院时间、住院费用及死亡率均显著降低。
