检查潜在可避免的心力衰竭住院的负担
Marya D Zilberberg1, Brian H Nathanson2, Kate Sulham3
1EviMed Research Group, LLC, Goshen, MA, USA.
ClinicoEconomics and outcomes research : CEOR
|October 5, 2023
概括
近一半的短期心力衰竭住院是轻度的,可能是可以避免的,可能节省大量的成本. 这些患者主要是因为流体管理而入院,死亡率和再入院率较低.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 美国每年心力衰竭住院病例超过100万例,其中三分之二仅仅是尿液注射.
- 这些住院治疗的很大一部分是可以预防的.
- 这项研究侧重于一个特定的队列:因心力衰竭 (CHF) 住院的低严重性,短期 (<=4天) 患者.
研究的目的:
- 为了对低严重性,短期心力衰竭患者的种群进行表征.
- 将低严重性心力衰竭 (CHF-L) 患者与高严重性心力衰竭 (CHF-H) 患者的基线特征,护理过程和结果进行比较.
- 通过避免不必要的入院,评估节省成本的潜力.
主要方法:
- 从2016-2021年使用Premier医疗保健数据库进行回顾性队列研究.
- 用行政代码算法定义的心力衰竭 (CHF).
- 基于临床指标的低严重性 (CHF-L) 和高严重性 (CHF-H) 分类,如心脏性休克,需要呼吸/循环支持,以及查尔森并发症指数.
主要成果:
- 在301,672名短期住院CHF患者中,44.8%被归类为CHF-L.
- 与CHF-H相比,CHF-L患者更年轻,更常见的是女性,住院死亡率较低 (0.2%对1.5%) 和30天再入院率较低 (8.1%对10.5%).
- 在这两组中,抗凝药是最常见的非利尿剂IV治疗,CHF-H的患病率更高 (33.3%对23.8%).
结论:
- 大约一半的短期心力衰竭入院是低严重性 (CHF-L),主要是用于流体管理.
- 避免这些CHF-L入院可能会导致医疗保健成本大幅节省.
- 进一步研究预防这些特定入院的策略是有必要的.
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