A Study About The Risk Factors Of Readmission In Patients With Chronic Heart Failure In Tianjin

ObjectiveTo acquire and master the etiological factors of patient who suffered from chronic heart failure(CHF) in Tianjin and relevant circumstance of taking medicine prior to readmission and the extent of conformity of treatment with international guidelines. To find out the inner relationship and hierarchy that resulted in the readmission of CHF patients via COX model and the logistic multi-factor regression analysis. MethodWe extract 1594 cases of patients who were admitted to the second hospital of Tianjin medical university cardiology department from 2011.12.1 to 2013.3.31 for CHF as the main etiology, among them are 858 cases male patients, 736 cases female patients, the average age is 71.64+10.719 years old. We use the first of admission case for the patients who was admitted to hospital twice or more, then we use corresponding statistical method to intergrated input all patients relevant clinical data. Thereafter, we conducted a one-year follow-up visit by the telephone and outpatient visit, the date of the final follow-up is 2014.4.30. The readmission caused by the aggravation of heart failure symptoms and clinical death caused by circulatory failure were included as cutoff criteria. Once cut off criteria was reached, the follow-up visit was terminated. If the patient didn’t reach the cutoff criteria before the end date of the follow-up visit, the follow-up visit was also terminated and included into the statistics. We use logistic multi-factor regression analysis and COX proportional hazard regression mode to investigate the readmission of CHF patients in Tianjin who accepted one-year treatment. Also, the impact of factors such as age, gender, cardic function, complication, medication use, hospital stay on the readmission condition should be analyzed. Results1 Before the end date of follow-up visit, 1060 patients in all rehospitalized for the aggravation of heart failure. We don’t exclude the factors such as the patients cases included is too less and the time span is too short. There is no death among the objects of this research.2 Drug treatment compliance of patients in this study is high, about 88.4% interviewers use the oral medication of angiotensin converting enzyme inhibitors(ACEI) or angiotensin II receptor blocker(ABb) as the first-line treatment, about 876 interviewers use beta blockers(Bb) as the first-line treatment drugs(55.2%). Approximately 430 interviewers(27.1%) use ACEI and BB combined oral medication as first-line treatment, this ratio is lower than international guidelines.3 The admission cardic function evaluation, the average hospitalization days, the basal heart rate and different treatment methods to use oral drugs in accordance with international guidelines recommendation are all contribute to readmission for CHF treatment in different extent. The readmission rate of cardic arrhythmias in patients with chronic heart failure is 144.2% to compare with normal basal heart rat in patients with chronic heart failure(P<0.01). The increased average hospitalization days of patients with chronic heart failure and the rate of readmission are positively correlated, the ratio of the number of days and the risk of readmission is about 2.21%(P<0.01); The New York Heart Association(NYHA) is used as index to evaluate cardic function. The cardic function evaluation and increased admission rate are also positively relevant, the ratio is 19.3%(P<0.05); The use of heart failure oral drugs, either alone or in combination should follow international guidelines. And it is effective measures to lower the readmission rate of patients with heart failure.4 The patients prescribed at least both ACEI and ARB(High group)had significantly fewer readmissions for heart failure exacerbation than without either ACEI or BB(P < 0.01). Patients prescribed at least ACEI and BB together with one(High+otherl versus Low GA ab+1, P = 0.048)or two(High GA ab+2 versus Low GA ab+2, P 二 0.003) of the 3 other HF drugs, namely spironolactone, diuretics and a cardiac glycoside, also had significantly fewer readmissions for heart failure exacerbation than respective counterparts.5 According to the statistics included, the median time to recurrence of heart failure is the 323 th day in patients with heart failure.()6 Single analysis displayed that there are discrepant results regarding the rte of readmission in one year after treatment. Factors changed included age, left ventricular end-diastolic diameter, left ventricular posterior wall thickness, whether patients with hypertension complicated with hyperlipermia or not, whether concomitant with anxiety and depression or not.7 Logistic regression analysis indicated that elder age, the increased left ventricular end-diastolic diameter and left ventricular posterior wall thickness complicated with hypertension hyperlipermia and diabetes, concomitanted with negative emotion as anxiety and depression are risk factors of readmission in one year after treatment. ConclusionAverage hospitalization days, complication, admission New York Association functional class, heart of color Doppler ultrasound index and age are all independent risk factors contribute to the readmission of patients with chronic heart failure, while use ACEI(or ARB) and Bb according to international guidelines, either alone or in combination, is independent protective factor which can lower the rate of readmission of patients with heart failure.