及时的门诊可以减少心力衰竭患者的再入院和死亡率吗?
Ishwarya Balasubramanian1, Chetna Malhotra2,3,
1Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore.
Journal of general internal medicine
|April 10, 2024
概括
在医院出院后30天内进行门诊随访,可显著降低心力衰竭患者的不良事件. 益处因患者的复杂性而异,突出了个性化后续策略的需要.
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
- 临床医学 临床医学
背景情况:
- 出院后的门诊随访可能会减少医院再入院.
- 现有关于门诊随访有效性的证据存在方法学上的局限性.
- 心力衰竭 (HF) 患者面临重新入院和死亡的高风险.
研究的目的:
- 评估门诊随访时间 (在7,14,21,30天内) 对30天内HF患者的再入院或死亡率的影响.
- 为了确定门诊随访的效果是否根据患者的临床复杂性而有所不同.
主要方法:
- 从前性队列研究 (2016年1月至2021年12月) 中分析医疗记录.
- 利用时间变化的混合效应参数生存模型来评估门诊随访缺乏和不良事件之间的关联.
- 采用交互模型来探索不同患者复杂性 (并发症,握力,认知功能,停留时间) 的随访效果的差异.
主要成果:
- 没有门诊随访显著增加了30天所有原因不良事件的风险.
- 在21天后,患有特定复杂症的患者的不良事件风险显著增加:一种并发症,轻度/中度认知障碍,正常的握力和7至13天的住院时间.
- 对不同后续延迟 (例如,14,21,30天) 量化了特定风险增加.
结论:
- 退院后30天内的门诊随访与心力衰竭患者30天不良事件的减少有关.
- 门诊随访的好处是根据患者的临床复杂性进行调整的.
- 建议优先考虑高风险HF患者的门诊随访,以最大限度地提高益处并减少不良事件.
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