目的:验证欧洲联合评估对急性失代性心力衰竭(ELAN-HF)评分的预测价值,并评估自我护理行为对急性失代偿性心力衰竭(ADHF)患者入院后再入院和死亡率的影响。
方法:定量,prospective,单中心,队列研究。
方法:在入院和出院时测量N末端B型利钠肽前体(NT-proBNP)水平,并与临床和实验室参数一起用于计算ELAN-HF评分。将患者分为四个风险组(低,中间,高,非常高)根据他们的ELAN-HF评分。评估ELAN-HF评分的表现并与原始研究进行比较。通过欧洲心力衰竭自我护理行为量表(EHFScBS-9)评估自我护理行为。生存分析用于评估评分与180天内HF和/或全因死亡率的再入院之间的关联。
结果:纳入88例患者。研究人群的中位年龄为75岁(IQR69-83),43%是女性。出院时出现NYHAIII/IV功能分级的患者有68例(85%),27例(34%)左心室射血分数<40%。80例患者获得了完整的数据和180天的随访。55%达到再入院和/或全因死亡率终点。ELAN-HF评分与再入院和/或死亡率<180天之间存在显著关联(HR=1.25,95%CI1.08-1.45,p=0.003)。EHFScBS-9评分中位数为68.1(IQR58.3-77.8)。EHFScBS-9评分与<180天的再入院和/或死亡率之间没有显着关联(HR=1.01,95%CI0.99-1.03,p=0.174)。
结论:本研究证实了ELAN-HF评分在出院前对ADHF患者进行分诊的有效性和潜力。使用此评分可以优化护士主导的心力衰竭诊所的后续治疗,以降低再入院率和死亡率。在我们的研究人群中,自我护理行为与再入院和/或死亡率没有显着相关。
背景:本研究已在MEC-U伦理委员会注册(Nieuwegein,荷兰),注册编号:V.160999/W18.208/HG/mk。
OBJECTIVE: To validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF).
METHODS: Quantitative, prospective, single centre, cohort study.
METHODS: N-Terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days.
RESULTS: 88 patients were included. The median age of the study population was 75 years (IQR 69-83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08-1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 - 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99-1.03, p = 0.174).
CONCLUSIONS: This study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population.
BACKGROUND: This study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.