Single Center Survey Of Chronic Heart Failure Re-hospitalization Rate And Related Factors

Objective:(1)Get to know the re-hospitalization rate of the chronic cardiac failure and the death rate.(2)Research and analyze the multiple related factors that impacting the re-hospitalization of chronic cardiac failure in order to prepare a proper internal and external management plan and provide the base-line data support to reduce the re-hospitalization rate and cost.(3)Calculate the total hospitalization cost of each patient in order to estimate the spending on the diagnosis and treatment of the cardiac failure in this province,thus providing the reference for the medical system reform.Methods:Capture data from the patients receiving treatment from December 2014 to April 2015 in Hunan Provincial People's Hospital,by tracking the living life method,medicine,drug compliance,self-management and the re-hospitalization and death condition,the re-hospitalization rate and death rate can be calculated by 1 month,3 months,6 months,12 months after the patients' leaving the hospital.With the Kaplan-Meier method and cox regression analysis,the impacting factors to the cardiac failure can be discussed,and also the costs spent during the hospitalization can be calculated.Results:(1)in total 196 patients with cardiac failure are randomly interviewed,including 100 males and 96 females,average age 67.98±13.289;maximum interviewing 365 days(12 months),average interviewing 319 days(approximately 10 months).The main cause of the disease is coronary disease(44.4%),and subsequently followed by cardiomyopathy(27.0%),high blood pressure(13.3%),Valvular heart disease(11.7%).And among these,there are 74 atrial fibrillation(37.8),and only 29 accept anticoagulant therapy(2)For the patients with chronic heart failure,the single utilization rate of the ACEI/ARB type medicine(Renin angiotensin converting enzyme inhibitors/Angiotensin receptor blockers),? retarder(? blockers)and spirolactone(aldosterone receptor antagonist)is 81.1%?66.3%?76.0%respectively,whereas the simultaneous utilization rate is 44.9%.(3)The re-hospitalization rate after the patients leave the hospital after 1 month,3 months,6 months and 12 months is 10.7%?27.6%?45.9%and 58.2%respectively,and the death rate is 3.6%?4.1%?6.6%and 8.7%respectively.First three months,hospitalization rates increased gradually,peaked at the third month(12.69%),then began to decline.Mortality rate reached its peak in the first month(3.57%).(4)Kaplan-Mier survival curve comparison shows,there is an obvious calculous difference in the living limit comparison in ages(Log-rank x2=8.848,P=0.003),gender(Log-rank x 2=7.221,P=0.007),diagnosis year(Log-rank x2=4.867,P=0.027),working condition(Log-rank x2 =10.930,P=0.004),complication number(Log-rank x 2=7.107,P=0.029),whether they have atrial fibrillation or not(Log-rank x2=4.812,P=0.028),anemia(Log-rank x2=13.068,P=0.000),NT-proBNP level(Amino terminal brain natriuretic peptide precursor)(Log-rank x2=4.316,P=0.038),and drug-taking compliance(Log-rank x2=17.308,P=0.000).Cox regression analysis shows,Working condition(RR=1.581,P=0.021).atrial fibrillation(RR=0.492,P=0.000)?NT-proBNP level(RR=0.618,P=0.015)?drug-taking compliance(RR=2.151,P=0.000)are the main factors influencing the re-hospitalization rate of the chronic cardiac failure.(5)For all the 200 patients with chronic heart failure,the total cost is around 2.8 million CNY,average 14028.87 CNY each person,account for 10.5%of the center treatment during the same period,and the average person reimbursement rate is 65.04%%±16.12%.Conclusion:(1)The re-hospitalization rate after the patients leave the hospital after 1 month,3 months,6 months and 12 months is 10.7%?27.6%?45.9%and 58.2%respectively,and the death rate is 3.6%?4.1%?6.6%and 8.7%respectively?Re-hospitalization and mortality rates reached the peak at the third and first month atter discharge,so we need enhance the management of the vulnerable period.(2)Working condition,atrial fibrillation,NT-proBNP level,and drug-taking compliance are the main factors influencing the re-hospitalization rate of the chronic cardiac failure.(3)The simultaneous utilization rate of the ACEI/ARB type medicine,? retarder and spirolactone is still low among inpatients with chronic heart failure.(4)Atrial fibrillation is a common arrhythmia in heart failure patients,and their utilization rate of anticoagulant drugs is low clinically.(5)The health spending of chronic heart failure brought a huge burden to family and society,so countries should provide balancing health care according to the onset and distribution of chronic heart failure.