北京市通州区CHF治疗状况和再住院影响因素分析

An analysis on influence factors of treatment situation and readmission in patients with chronic heart failure(CHF) in Beijing Tongzhou District

目的调查北京市通州区慢性心力衰竭(CHF)患者治疗现状,分析影响该地区CHF患者再入院的因素。方法选择2015年1月~12月连续在首都医科大学附属北京潞河医院心内科住院的CHF患者301例患者,其中男性177例,女性124例,年龄27~89岁,平均年龄(71.49±11.75)岁。6月后通过门诊或电话随访,根据是否再入院,分为2组,分别是再人院组(142例)和对照组(159例),并分析影响CHF患者再入院的因素。结果 CHF主要病因是冠心病197例(65.5%),其次是心脏瓣膜病48例(15.9%),心肌病31例(10.3%)和高血压心脏病25例(8.3%)。CHF主要诱因是水潴留(74.8%)和肺感染(43.9%)。再住院组患者年龄≥70岁、左室射血分数(LVEF)≤35%、合并肾功能不全、贫血、慢性阻塞性肺疾病的比例明显高于对照组,差异有统计学意义(P均<0.05)。再住院组的阿司匹林、呋塞米、ACEI/ARB的服药率明显低于对照组;再住院组监测体重、服药依从性、定期门诊随诊的比率明显低于对照组,差异有统计学意义(P均<0.05)。Logistic多因素分析发现影响CHF患者再住院的因素为:监测体重(OR=0.285,95%CI:0.147~0.555)、肾功能不全(OR=2.137,95%CI:1.264~3.612)、LVEF>35%(OR=0.449,95%CI:1.264~3.612)、服药依从性(OR=0.503,95%CI:0.279~0.906)、呋塞米(OR=0.389,95%CI:0.171~0.884)、慢性阻塞性肺疾病(OR=2.156,95%CI:1.070~4.343)和ACEI/ARB(OR=0.574,95%CI:0.344~0.959)。结论导致CHF的主要疾病是冠心病,主要诱因为水潴留和肺感染。CHF患者ACEI/ARB、β-受体阻滞剂应用率偏低,缺乏CHF自我管理。监测体重、肾功能不全、LVEF>35%、服药依从性、呋塞米、慢性阻塞性肺疾病和ACEI/ARB是预测CHF患者再住院的独立因素。

Objective To survey the present status of treatment of chronic heart failure （CHF）, and analyze influence factors of readmission in CHF patients in Beijing Tongzhou District. Methods CHF patients （n=301, male 177, female 124, aged from 27 to 89 and average age=71.49±11.75） were chosen from the Department of Cardiovascular Diseases of Beijing Luhe Hospital affiliated to Capital University of Medical Sciences from Jan. 2015 to Dec. 2015. All patients were followed up through clinics and telephones after 6 m, and then divided into readmission group （n=142） and control group （n=159）. The factors influencing readmission were analyzed. Results The major causes of CHF were coronary heart disease （CHD, n=197, 65.5%）, valvular disease （n=48, 15.9%）, cardiomyopathy （n=31, 10.3%） and hypertensive heart disease （n=25, 8.3%）. The major inducements of CHF were water retention （74.8%） and pulmonary infection （43.9%）. The percentages of patients aged≥70, with LVEF≤35%, and complicated by renal insufficiency, anemia and chronic obstructive pulmonary disease （COPD） were significantly higher in readmission group than those in control group （all P〈0.05）. The drug-taking rates of aspirin, furosemide and ACEI/ARB, monitored weight, medication compliance and percentage of regular clinic visiting and follow-up clinic were significantly lower in readmission group than those in control group （all P〈0.05）.Logistic multi-factor analysis showed that monitored weight （OR=0.285, 95%CI： 0.147-0.555）, renal insufficiency （OR=2.137, 95%CI： 1.264-3.612）, LVEF〉35% （OR=0.449, 95%CI： 1.264-3.612）, medication compliance （OR=0.503, 95%CI： 0.279-0.906）, furosemide （OR=0.389, 95%CI： 0.171-0.884）, COPD （OR=2.156, 95%CI： 1.070-4.343） and ACEI/ARB （OR=0.574, 95%CI： 0.344-0.959） were influence factors of readmission. Conclusion The major disease inducing CHF is CHD and major inducements are water retention and pulmonary infection. The medication rates of ACEI/ARB and β-receptor blocker are lower, which indicates the lack of self-management in CHF patients. The monitored weight, renal insufficiency, LVEF〉35%, medication compliance, furosemide, COPD and ACEI/ARB are independent factors for predicting readmission in CHF patients.