湖南部分地区慢性心力衰竭再入院率及影响因素调查

Investigation on readmission rate and influencing factors of chronic heart failure in some areas of Hunan Province

目的:了解湖南省部分地区慢性心力衰竭的再住院率及死亡率及住院患者临床特点,分析影响慢性心力衰竭再住院的危险因素。方法:根据统计学非概率抽样方法,使用便利抽样抽取东部长沙、西部怀化、南部郴州、中部娄底、北部石门和岳阳6个地区的6家三甲医院,选取2015年3月~9月在各调查医院心内科住院并好转出院的心功能III-IV级(NYHA分级)的慢性心力衰竭患者为研究对象,收集患者的社会人口资料、临床资料,出院后每月随访患者的生存情况,包括因心力衰竭再入院或者死亡情况,统计出院后30天、3个月、6个月、12个月再住院率及死亡率,运用生存分析Kaplan-meier法,探讨慢性心力衰竭住院患者再入院的影响因素。结果:本次调查纳入514例慢性心力衰竭住院患者,男性274例,女性240例,射血分数保留心力衰竭(HFpEF)患者占52.5%,射血分数减低心力衰竭(HFrEF)患者占47.5%。心衰合并症分别为冠心病(57.3%)、高血压(52.7%)、心律失常(48.2%)、糖尿病(26.5%)、贫血(20.6%)。在用药方面,ACEI/ARB,β受体阻滞剂,螺内酯的平均使用率为分别为73%,59.5%及73.3%,联合使用率为36.4%;洋地黄类药物使用率平均是45.3%,血管扩张剂如硝普钠、硝酸酯类药物在各个调查医院平均使用率为56.8%、70.2%;冠脉搭桥、支架植入、植入式电装置如CRT/ICD 在各个调查医院平均应用率为0.4%,2.5%,0.6%。慢性心力衰竭住院患者出院后30 天、3 个月、6 个月及12个月累积再入院率分别为10%、26%、42%、52%,30 天、3 个月、6个月及12 个月累积死亡率分别为3%、5%、9%、12%;不同诊断年限、是否合并房颤为影响死亡率的独立因素。结论:湖南部分地区慢性心力衰竭总体男性多于女性,男女比例为1.14:1;合并症最常见为冠心病、高血压、心律失常,其中射血分数保留心力衰竭住院患者女性多于男性,合并冠心病、高血压、心律失常比例更高。湖南部分地区慢性心力衰竭金三角药物(ACEI/ARB、β受体阻滞剂、螺内酯)院内联合使用率、植入式电装置(CRT/ICD)使用率均较低。心衰患者再入院和死亡率均较高,诊断年限、是否合并房颤是慢性心力衰竭再入院率的影响因素。

Objective To understand the re-hospitalization rate,mortality rate and clinical characteristics of inpatients with chronic heart failure in some areas of Hunan province,and to analyze the risk factors affecting the re-hospitalization of chronic heart failure.Methods Data are collected conveniently on 514 patients with a primary diagnosis of HF who are enrolled from six participating hospitals of Hunan province from March to September 2015.HF patients enrolled in this research are followed on survival condition including readmission and death month by month for 1 year,then the readmission rate and mortality rate of 1 month,3 months,6 months 12 months would be calculated,and apply the Kaplan-Meier method to assess the related factors.Results There are 514 hospitalized heart failure patients enrolled and followed-up for 1 year,including 274 males and 240 females.Ejection fraction retention heart failure (HFpEF) accounted for 52.5%,and ejection fraction decreased heart failure (HFrEF) accounted for 47.5%.Common comorbidities included coronary heart disease (57.3%),hypertension (52.7%),arrhythmia (48.2%),diabetes (26.5%),anemia (20.6%).In terms of medication,the average utilization rates of ACEI/ARB,beta blocker and spironolactone is 73%,59.5% and 73.3% respectively,and the combined utilization rates are 36.4%.The average application rates of coronary artery bypass grafting,stenting,and implantable devices such as CRT/ICD is 0.4%,2.5%,and 0.6% in all surveyed hospitals.Hospitalized patients with chronic heart failure in 30 days,3 months,6 months,and 12 months after discharge,the cumulative readmission rates is 10%,26%,42% and 52%,and the cumulative mortality rates is 3%,5%,9% and 12%,respectively.Different years of diagnosis and whether atrial fibrillation is combined are independent factors affecting mortality.Conclusion In some areas of Hunan,The prevalence of chronic heart failure is higher in men than in women,the ratio is 1.14 to 1.The common complications are coronary heart disease,hypertension,and arrhythmia,among the ejection fraction retention heart failure are more common in women than in men,the proportion with coronary heart disease,hypertension,and arrhythmia is higher.In some areas of Hunan province,the utilization rate of combined drugs (ACEI/ARB,beta blocker and spironolactone) and Implantable electrical device (CRT/ICD) are all low.The readmission and mortality rates of patients with heart failure are higher,and the years of diagnosis and the presence or absence of atrial fibrillation are the influencing factors for the readmission rate of patients with chronic heart failure.