Fatores de risco associados a mortalidade intra-hospitalar ou readmissão em até 30 dias de pacientes idosos admitidos por insuficiência cardíaca pela emergência de hospital quaternário
Fatores de risco associados a mortalidade intra-hospitalar ou readmissão em até 30 dias de pacientes idosos admitidos por insuficiência cardíaca pela emergência de hospital quaternário
Data
2020
Autores
Coelho, Roberta Pereira dos Santos
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
A insuficiência cardíaca é um grave problema de saúde pública, e atinge de 1 a 2%
da população adulta mundial nos países desenvolvidos, e pode subir para 10% entre
pessoas maiores de 70 anos de idade.
Objetivo: Identificar fatores de risco associados a mortalidade intra-hospitalar e
readmissões em até 30 dias após alta em pacientes com insuficiência cardíaca.
Métodos: Este é um estudo de coorte retrospectivo, realizado entre o período de julho
de 2015 a janeiro de 2018. A inclusão no estudo foi definida através dos critérios de
inclusão e exclusão que incluem o tipo de IC sistólica e diastólica, escore de
framingham positivo, BNP ≥ 100pg/ml e/ou diurético venoso nas primeiras 24h da
internação. A análise consistiu em mediana com intervalo interquartílico para variáveis
contínuas e distribuição de frequência com intervalo de confiança de 95% para as
variáveis categóricas. Modelos de regressão logística com as correspondentes razões
de chance e intervalos de confiança foram realizados para determinar os desfechos
mortalidade intra-hospitalar e readmissão.
Resultados: Foram analisados 487 pacientes, na população geral a mediana de
idade foi de 84 anos (IIQ= 74 - 89), com predomínio de 56,38% do sexo masculino,
acima da metade da população (60,49%) apresentava disfunção do tipo sistólica do
VE e 45,89% dos pacientes eram obesos e sobrepesos com história de 4,12% de
fumantes. Observamos que o tempo de internação teve uma mediana de 6 (IIQ=4-
11,75) dias.Os fatores de risco associados a mortalidade intra-hospitalar foram, idade
(RC 1,056, IC 95% 1,013-1,101, p 0,01), diabetes mellitus (RC 2,638, IC 95% 1,22-
5,702, p 0,014), tempo de internação (RC 1,053, IC 95% 1,032-1,075, p < 0,001) e
história de ressincronização (RC 8,002, IC 95% 1,357-47,173, p 0,022). E os fatores
de risco associados a readmissão em até 30 dias após alta hospitalar foram, história
de marcapasso (RC 0,409, IC 95% 2,351-1,054, p 0,037), função glomerular (RC
0,005, IC 95% 1,015-1,005, p 0,004) e hemoglobina (RC 0,119 IC 95% 0,779-0,617,
p 0,036).
Conclusão: Os fatores de riscos que são controláveis, recomenda-se estratégias de
atenção integral precoce ao longo da vida focada na prevenção. E, se instalado o fator
de risco, a educação do paciente e profissional tem demonstrado cada vez mais a
importância em grandes desfechos como mortalidade intra-hospitalar e readmissão. Palavras-chave: Insuficiência Cardíaca; Insuficiência Cardíaca Sistólica; Insuficiência
Cardíaca Diastólica; Readmissão do Paciente; Mortalidade Hospitalar; Mortalidade
Intra-Hospitalar; Mortalidade
Heart failure is a serious public health problem, affecting 1 to 2% of the world's adult population in the affected countries, and can rise 10% among people over 70 years of age. Objective:To identify risk factors associated with in-hospital mortality and readmissions within 30 days after discharge in patients with heart failure. Methods: This is a retrospective study of the cohort, between the period of July 2015 and January 2018. An inclusion in the study is defined as a variable of selection and exclusion of use and type of systolic HF and diastolic, positive framingham score, BNP ≥ 100pg / ml and / or venous diuretic in the first 24 hours of hospitalization. An analysis consisted of median with interquartile range for continuous variables and frequency distribution with 95% confidence interval for variable variables. Logistic regression models with the following odds ratios and confidence intervals were performed to determine the outcomes of in-hospital mortality and readmission. Results: 487 patients were analyzed, with a general median age of 84 years (IIQ = 74 - 89), predominantly composed by males (56.38%), roughly half of the population (60.49%) with LV systolic dysfunction and 45.89% of the patients were obese and with a history of smoking (4.12%). We observed that the length of hospital stay had a median of 6 (IIQ = 4-11.75) days. In multivariate analysis, age (OR 1,056, CI 95% 1,013-1,101, p 0,01), diabetes mellitus (OR 2,638, CI 95% 1,22-5,702, p 0,014), length of hospital stay (OR 1,053, CI 95% 1,032-1,075, p < 0,001) and history of resynchronizer (OR 8,002, CI 95% 1,357-47,173, p 0,022) were associated with in hospital mortality. Risk factors associated with readmission within 30 days after hospital discharge, history of pacemaker (OR 0,409, CI 95% 2,351-1,054, p 0,037), glomerular function (OR 0,005, CI 95% 1,015-1,005, p 0,004) and hemoglobin (OR 0,119 IC 95% 0,779-0,617, p 0,036). Conclusion: The risk factors that are controllable, it is recommended to approach early comprehensive care throughout life focused on prevention. And if the risk factor is installed, patient and professional education is increasingly important in more outcomes as in in-hospital mortality and readmission. Keywords: Heart Failure; Systolic Heart Failure; Diastolic Heart Failure; Patient Readmission; Hospital Mortality; In-Hospital Mortality; Mortality
Heart failure is a serious public health problem, affecting 1 to 2% of the world's adult population in the affected countries, and can rise 10% among people over 70 years of age. Objective:To identify risk factors associated with in-hospital mortality and readmissions within 30 days after discharge in patients with heart failure. Methods: This is a retrospective study of the cohort, between the period of July 2015 and January 2018. An inclusion in the study is defined as a variable of selection and exclusion of use and type of systolic HF and diastolic, positive framingham score, BNP ≥ 100pg / ml and / or venous diuretic in the first 24 hours of hospitalization. An analysis consisted of median with interquartile range for continuous variables and frequency distribution with 95% confidence interval for variable variables. Logistic regression models with the following odds ratios and confidence intervals were performed to determine the outcomes of in-hospital mortality and readmission. Results: 487 patients were analyzed, with a general median age of 84 years (IIQ = 74 - 89), predominantly composed by males (56.38%), roughly half of the population (60.49%) with LV systolic dysfunction and 45.89% of the patients were obese and with a history of smoking (4.12%). We observed that the length of hospital stay had a median of 6 (IIQ = 4-11.75) days. In multivariate analysis, age (OR 1,056, CI 95% 1,013-1,101, p 0,01), diabetes mellitus (OR 2,638, CI 95% 1,22-5,702, p 0,014), length of hospital stay (OR 1,053, CI 95% 1,032-1,075, p < 0,001) and history of resynchronizer (OR 8,002, CI 95% 1,357-47,173, p 0,022) were associated with in hospital mortality. Risk factors associated with readmission within 30 days after hospital discharge, history of pacemaker (OR 0,409, CI 95% 2,351-1,054, p 0,037), glomerular function (OR 0,005, CI 95% 1,015-1,005, p 0,004) and hemoglobin (OR 0,119 IC 95% 0,779-0,617, p 0,036). Conclusion: The risk factors that are controllable, it is recommended to approach early comprehensive care throughout life focused on prevention. And if the risk factor is installed, patient and professional education is increasingly important in more outcomes as in in-hospital mortality and readmission. Keywords: Heart Failure; Systolic Heart Failure; Diastolic Heart Failure; Patient Readmission; Hospital Mortality; In-Hospital Mortality; Mortality
Description
Palavras-chave
Insuficiência cardíaca, Insuficiência Cardíaca Sistólica, Insuficiência Cardíaca Diastólica, Readmissão do Paciente, Mortalidade Hospitalar, Mortalidade Intra-Hospitalar, Mortalidade, Heart Failure, Systolic Heart Failure, Diastolic Heart Failure, Patient Readmission, Hospital Mortality, In-Hospital Mortality, Mortality
Citação
Coelho RPS. Fatores de risco associados a mortalidade intra-hospitalar ou readmissão em até 30 dias de pacientes idosos admitidos por insuficiência cardíaca pela emergência de hospital quaternário. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2020.