在急性不补偿性心力衰竭的临床稳定后早出院:与短期结果的关联
Gil Marcus1,2, Shiri L Maymon3,4, Eran Kalmanovich5,4
1Department of Cardiology, Shamir Medical Center, Be'er Ya'akov, Israel. gilmarcus.gm@gmail.com.
概括
1-2天后出院的急性不补偿性心力衰竭患者没有增加30天死亡率或再入院. 长时间住院 (≥7天) 与明显更高的风险有关,这表明住院时间长度反映了患者的复杂性.
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
背景情况:
- 对于急性不补偿性心力衰竭 (ADHF) 的住院时间 (LOS) 缺乏标准化值.
- 之前使用行政数据的研究表明,对于非常短的住院时间 (1-2天) 来说,结果是中性的,但由于潜在的未测量的临床严重性,引起了人们的担忧.
- 这项研究通过检查临床数据来解决对ADHF中LOS更细致的理解的需求.
研究的目的:
- 调查急性不补偿性心力衰竭 (ADHF) 住院患者住院时间 (LOS) 和30天全因再入院或死亡率之间的关联.
- 为了确定是否非常短 (1-2天) 或长时间 (≥7天) 的住院与标准住院 (3-6天) 相比,与不同的结果有关.
主要方法:
- 对2007年至2017年期间患有ADHF住院的成年患者进行了回顾性队列研究.
- 不包括在医院死亡和冠状动脉旁路移植 (CABG) 病例. LOS分为短期 (1-2天),标准 (3-6天) 和长期 (≥7天) 的类别.
- 考克斯模型和受限制的立方线被用来分析30天的所有原因的再入院或死亡率,以多个临床共变量进行调整.
主要成果:
- 分析包括7455名患者,短暂LOS组为14.4%,标准LOS组为46.4%,长期LOS组为39.2%.
- 短暂的LOS患者更年轻,并且患有慢性脏病和贫血等并发症较少.
- 调整后的分析显示,短期LOS的30天风险没有显著增加 (HR 0.86; p=0.081),但长期LOS的风险显著增加 (HR 1.37; p<0.001).
- 间隙分析显示了J形曲线,风险增加超过住院6天.
结论:
- 在选择的ADHF患者中,在1-2天后出院与30天再入院或死亡率的增加无关.
- 长时间住院 (≥7天) 确定了具有较高短期风险的子组.
- 住院时间长度作为临床复杂性的标志物,而不是ADHF结果的直接决定因素.
相关概念视频
Heart Failure III: Clinical Manifestations
637
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
637
Acute Respiratory Failure-I
1.1K
Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
1.1K
Acute Respiratory Failure-II
1.2K
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
1.2K
Acute Respiratory Failure-V
515
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
515
Heart Failure II: Pathophysiology
1.0K
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.0K
Pathophysiology of Heart Failure
4.0K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
4.0K


