远程随诊对单中心新冠疫情期间老年慢性心力衰竭患者的预后影响及再入院预测模型的建立与验证  

Effect of remote follow-up on the prognosis of elderly patients with chronic heart failure during COVID-19 and establishment and validation of readmission prediction model

作　　者：刘文婷[1] 关晓楠[1] 宗敏[1] 赵华[1] 胡玫 张建军[1] Liu Wenting;Guan Xiaonan;Zong Min;Zhao Hua;Hu Mei;Zhang Jianjun(Department of Cardiology,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100043,China.;不详)

机构地区：[1]首都医科大学附属北京朝阳医院心内科,北京100043

出　　处：《中国循证心血管医学杂志》2023年第2期157-161,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨在新冠疫情期间老年慢性心力衰竭(心衰)患者的治疗现状,分析影响老年慢性心衰患者再住院的危险因素。方法选择2020年1月至6月于首都医科大学附属北京朝阳医院心内科住院,年龄>65岁的慢性心衰(NYHAⅢ~Ⅳ级)患者286例。接受2周/次的远程随访137例作为随诊组,其中男性72例,平均年龄(77.38±7.09)岁。未接受远程随访患者149例作为对照组,其中男性70例,平均年龄(77.11±7.53)岁。对比两组患者出院后12个月内再次入院率和死亡率。多因素Cox生存回归分析影响再住院的因素。结果随诊组再入院率(19.7%),对照组再入院率(40.3%),两组间再入院率差异具有统计学意义(P=0.000)。多因素Cox回归分析显示肾功能不全、瓣膜病、感染、自行停药是再入院的独立危险因素,远程随诊是再入院的保护因素。决策曲线分析显示回归模型在概率为0.1~0.8之间有临床获益。结论新冠疫情期间老年慢性心衰患者再入院的危险因素是肾功能不全、瓣膜病、感染、自行停药,保护因素是远程随诊。远程随诊可显著降低新冠疫情期间老年慢性心衰患者再入院率。以此构建的风险预测模型可为临床提供参考。Objective To explore the treatment status of patients with chronic heart failure during the epidemic period of the COVID-19 outbreak and analyze the factors affecting the re-hospitalization of patients with chronic heart failure.Methods 286 patients were chosen from our hospital from January 26,2020 June 30,2020.All patients were greater than 65 years old and were diagnosed with chronic heart failure(NYHAⅢ~Ⅳ).137 patients were followed up every 2 weeks as the follow-up group,including 72 males with an average age of(77.38±7.09)years.149 patients were not regularly followed up as the control group,including 70 males with an average age of(77.11±7.53)years.The readmission rate and mortality within 12 months after discharge were compared between the two groups.The factors influencing readmission were analyzed by Multivariate Cox regression.Results The readmission rate was 19.7%in the follow-up group and 40.3%in the control group.There was a significant difference between the two groups(P=0.000).Multivariate Cox regression analysis showed that renal insufficiency,valvular disease,infection and self withdrawal were independent risk factors for readmission,while remote follow-up was protective factor for re-entry.Decision curve analysis showed that the model had clinical benefit when the probability was 0.1~0.8.Conclusion The risk factors of readmission in elderly patients with chronic heart failure are renal insufficiency,valvular disease,infection,self withdrawal of drugs,and the protective factor is remote follow-up.Remote follow-up can significantly reduce the readmission rate of elderly patients with chronic heart failure.The risk prediction model can provide reference for clinical practice.

关 键 词：心力衰竭 再入院 危险因素 随访 

分 类 号：R541.61[医药卫生—心血管疾病]