Advances in Clinical and Experimental Medicine
2019, vol. 28, nr 4, April, p. 489–498
Publication type: original article
The journey of the heart failure patient, based on data from a single center
1 Department of Noninvasive Cardiology, Chair of Internal Medicine and Cardiology, Medical University of Lodz, Poland
Background. Care for patients with heart failure (HF) in Poland requires improvement.
Objectives. The aim of this study was to define the journey of the HF patient, taking into account the specialization of the hospital ward and further, highly specialized outpatient care.
Material and Methods. Using the medical system CliniNET®, we analyzed 214 consecutive patients hospitalized due to HF (International Statistical Classification of Diseases and Health Related Problems – ICD-10: I50) in the period from September 1 to December 31, 2015, and also the data from post-discharge outpatient care in a 3-month period. To fairly compare the management of care and outcomes of patients hospitalized in the internal medicine (IM) ward and in the cardiac ward, propensity score matching was performed. The multivariate regression analysis was performed to determine the independent predictors of the hospital ward selection and the risk of rehospitalization due to HF and/or death.
Results. The majority of patients were hospitalized due to HF for the first time (72%) and in the cardiac ward (65%). For 55% of rehospitalized patients, the subsequent admission was within 3 months after initial discharge. The independent predictors of a higher risk of rehospitalization due to HF and/or death were ischemic heart disease, atrial fibrillation (AF), chronic kidney disease (CKD), mineralocorticoid antagonism (MRA) therapy, and hospitalization in the last year (for all, p < 0.05). Internal medicine ward patients differed from cardiac ward patients in: mode of admission (urgent 100% vs 83.5%; p < 0.001), length of hospitalization (median: 8 days vs 5 days; p = 0.001), death rate (24% vs 4.3%; p < 0.001), echocardiography (43% vs 98%; p < 0.001), and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) measurements (43% vs 96%; p < 0.001). The burden of 5–9 accompanying diseases enhanced the choice of the cardiac ward (p < 0.05), while age and urgent mode of hospitalization decreased the chance of being referred to the cardiac ward (p < 0.01). Cardiac patients were more likely to receive β-blockers, diuretics, angiotensin receptor blockers (ARB), and MRA. Over 90% of cardiac ward patients were referred to cardiac ambulatory care after discharge from hospital, while among patients discharged from the IM ward, this rate was 60% (p < 0.001).
Conclusion. There were significant differences among the 2 wards in relation to the course of hospitalization and post-discharge outpatient care.
heart failure, hospitalization, cardiology, internal medicine
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