慢性心力衰竭患者再入院调查及影响因素分析

General situation and influencing factors of readmission in patients with chronic heart failure

目的探讨慢性心力衰竭(心衰)患者再入院现状,并分析其影响因素,为降低再入院风险提供参考依据。方法以2019年1月至2021年12月青岛市某医院住院治疗的慢性心衰患者为研究对象,收集出院前的人口学资料、心功能分级数据及相关生理生化检测结果,并对患者开展出院1年内的再入院跟踪随访。采用描述性分析方法对再入院情况进行描述,并采用单、多因素分析方法对患者再入院的相关因素进行分析。结果共纳入2229例慢性心衰患者为研究对象,出院后随访1年期间,死亡9例,失访4例,最终纳入2216例。其中男性占59.61%,女性占40.39%;年龄49~91岁,病程0.1~13年,5~<10年所占比例较高(35.29%)。随访1年期间再次入院973例,再入院发生率43.91%。其中出院后随访3个月内再入院372例(16.79%),6个月内889例(40.12%)。Cox回归模型分析结果表明年龄(HR=1.895)、独居(HR=1.793)、病程(HR=3.053)、出院时心功能分级(HR=11.462)、LVEF≤35%(HR=3.518)、合并肾功能不全(HR=6.801)、营养不良(HR=5.058)、脑钠肽升高(HR=6.190)、贫血(HR=6.373)、抑郁(HR=3.435)、服药依从性(HR=0.107)、低钠限水饮食(HR=0.159)和规律有氧运动(HR=0.209)均是影响慢性心衰患者出院后随访1年内再次入院的独立影响因素。结论慢性心衰患者短期再入院风险较高,且主要集中在出院后3~6个月,应重点关注高龄、独居、病程长以及合并肾功能不全、贫血等高危人群,鼓励患者出院后坚持低盐饮食和规律有氧运动的生活方式,培养患者良好的药物治疗依从性以及保持良好心态,从而有效降低患者再入院风险,提高生存质量。

Objective To explore the current situation of readmission in patients with chronic heart failure and analyze its influencing factors,so as to provide the reference for reducing the risk of readmission.Methods Patients with chronic heart failure hospitalized in a hospital in Qingdao City from January 2019 to December 2021 were selected for this survey.Demographic data,cardiac function grading data,and related physiological and biochemical test results before discharge were collected,and readmission follow-up within 1 year of discharge was carried out.Descriptive analysis method was used to describe readmission status,univariate and multivariate analysis methods were used to analyze the relevant factors of readmission.Results A total of 2229 patients with chronic heart failure were included as the study subjects.During a one-year follow-up period after discharge,9 died and 4 were lost to follow-up.Finally,2216 patients were included,of whom 59.61%were males and 40.39%were females,aged 49-91,with a course of disease of 0.1-13 years,and mainly 5-10 years(35.29%).During the one-year follow-up period,973 cases were readmitted,with a readmission rate of 43.91%.Among them,372 cases(16.79%)were readmitted within 3 months after discharge,and 889 cases(40.12%)were readmitted within 6 months.The Cox regression model analysis showed that age(HR=1.895),living alone(HR=1.793),course of disease(HR=3.053),cardiac function grading at discharge(HR=11.462),LVEF≤35%(HR=3.518),complicated with renal insufficiency(HR=6.801),malnutrition(HR=5.058),elevated brain natriuretic peptide(HR=6.190),anemia(HR=6.373),depression(HR=3.435),medication adherence(HR=0.107),low sodium and water limited diet(HR=0.159),and regular aerobic exercise(HR=0.209)were independent influencing factors that affect readmission of patients with chronic heart failure within one year of follow-up after discharge.Conclusions Patients with chronic heart failure have a high risk of short-term readmission,which is mainly concentrated in 3-6 months after discharge.Attention should be paid to high-risk groups such as the elderly,living alone,with a long course of disease,and complicated with renal insufficiency and anemia.Patients should be encouraged to adhere to a low-salt diet and regular aerobic exercise lifestyle after discharge,and cultivate good medication adherence and maintain a good attitude.Thus,the risk of readmission can be effectively reduced and the quality of life can be improved.