心脏康复 心脏衰竭后使用 住院治疗 与高级心脏衰竭中心状况相关
Michael P Thompson1, Hechuan Hou, Max Fliegner
1Author Affiliations: Section for Health Services Research and Quality, Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (Drs Thompson and Likosky and Ms Hou); Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor (Drs Thompson and Likosky); School of Medicine, Oakland University William Beaumont, Auburn Hills, Michigan (Mr Fliegner); Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Guduguntla); Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor (Drs Cascino, Aaronson, and Sukul); and Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan (Dr Keteyian).
在先进的心力衰竭中心住院的心力衰竭患者中,心力衰竭患者的心力衰竭率降低,更有可能参加心脏康复 (CR). 这表明先进的中心可能会改善心力衰竭患者的CR利用率.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 心脏康复 (CR) 是一种关键的,基于证据的治疗方法,用于心力衰竭患者,心力衰竭患者的减少喷射率 (HFrEF).
- 尽管有好处,但CR在这个患者群体中仍未得到充分利用.
- 识别增加CR参与的因素对于质量改善举措至关重要.
研究的目的:
- 调查提供高级心力衰竭 (HF) 治疗的中心住院治疗与HFrEF患者随后的CR参与之间的关联.
- 确定先进的高频中心状态是否会影响CR启动的可能性和及时性.
主要方法:
- 对2008年至2018年期间被诊断患有HFrEF的医疗保险受益人的回顾性分析.
- 关于CR利用 (出席,时间,完成) 的数据是从门诊病人的索赔中提取的.
- 使用后勤回归来评估高级HF中心状态与CR参与之间的关联,控制患者,医院和区域因素.
主要成果:
- 在143,392名受益者中,有20.6%被录取到先进的HF中心 (HFC).
- 只有3.7%的受理者在解雇后的一年内参加了CR.
- 在先进的HFC医院住院显著增加了CR参与的几率 (OR=2.20) 并导致更早的启动 (-8.5天).
结论:
- 在先进的HF中心住院的HFrEF医疗保险受益人显示,与非先进中心的受益人相比,退院后CR出席率更高.
- 先进的HF中心状态与CR利用率的增加有关,特别是在更早开始治疗时.
- 参与CR的强度 (会话数量或完成) 与高级HFC状态没有显著关联.
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