目的:考虑使用左心室辅助装置(LVADs)的晚期心力衰竭和显著的合并症和社会障碍患者数量的增加。我们试图检查LVAD植入后的医疗保健利用率,包括个人层面的社会经济地位和多发病率的影响。
结果:我们进行了一项丹麦全国队列研究,将来自临床LVAD数据库的个体水平数据联系起来,Scandiatransplant数据库,和丹麦国家医疗和行政登记处。社会经济地位包括同居地位,教育水平,和就业状况。多症定义为来自至少两个慢性疾病组的两种或更多种慢性病症。医疗保健利用(医院活动,一般实践活动,和兑换的医疗处方)在LVAD植入后2年内使用描述性统计每隔0.5年进行评估。我们确定了2006年至2018年间首次植入LVAD的119例患者存活出院。患者的中位年龄为56.1岁,男性占88.2%。随访患者直到心脏移植,LVAD外植体,死亡,2018年12月31日,或2年。中位随访时间为0.8年。与随后的随访间隔0.5-1、1-1.5和1.5-2年相比,LVAD出院后0-0.5年使用医疗保健服务的中位数最高。分别。住院的中位数(四分位数范围)为10(7-14),第14天(9-28天),门诊8次(5-12次),与全科医生的电话联系4(2-8),LVAD出院后0-0.5年内的总赎回医疗处方26(19-37),与连续随访期内的中位使用率相比[例如0.5-1年内:住院5(3-8),第8天(4-14天),门诊5次(3-8次),电话联系人2(0-5),并兑换医疗处方24(18-30)]。从0.5年开始,医疗保健服务的使用中位数保持稳定。LVAD植入后0-0.5年内,教育水平低或就业状况低的独居患者的住院和卧床天数中位数略高。最后,在预先存在多重性疾病的患者中,住院天数和已兑换处方的中位数较高.
结论:在接受LVAD植入的患者中,在LVAD出院后的早期阶段,医疗保健利用率很高,并且受到社会经济地位的影响。多症影响住院天数,并在2年随访期间兑换处方。
OBJECTIVE: Increasing numbers of patients with advanced heart failure and significant comorbidity and social barriers are considered for left ventricular assist devices (LVADs). We sought to examine health care utilization post-LVAD implantation, including the influence of individual-level socio-economic position and multimorbidity.
RESULTS: We conducted a Danish nationwide cohort study linking individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish national medical and administrative registries. Socio-economic position included cohabitation status, educational level, and employment status. Multimorbidity was defined as two or more chronic conditions from at least two chronic disease groups. Health care utilization (hospital activity, general practice activity, and redeemed medical prescriptions) within 2 years post-discharge after LVAD implantation was evaluated using descriptive statistics at 0.5 year intervals. We identified 119 patients discharged alive with first-time LVAD implanted between 2006 and 2018. The median age of the patients was 56.1 years, and 88.2% were male. Patients were followed until heart transplantation, LVAD explantation, death, 31 December 2018, or for 2 years. The median follow-up was 0.8 years. The highest median use of health care services was observed 0-0.5 years post-LVAD discharge compared with the subsequent follow-up intervals: 0.5-1, 1-1.5, and 1.5-2 years, respectively. The median (interquartile range) number of hospitalizations was 10 (7-14), bed days 14 (9-28), outpatient visits 8 (5-12), telephone contacts with a general practitioner 4 (2-8), and total redeemed medical prescriptions 26 (19-37) within 0-0.5 years post-LVAD discharge compared with the median utilization within the consecutive follow-up periods [e.g. within 0.5-1 year: hospitalizations 5 (3-8), bed days 8 (4-14), outpatient visits 5 (3-8), telephone contacts 2 (0-5), and redeemed medical prescriptions 24 (18-30)]. The median use of health care services was stable from 0.5 years onwards. The median number of hospitalizations and bed days was slightly higher in patients living alone with a low educational level or low employment status within 0-0.5 years post-LVAD implantation. Finally, the median number of in-hospital days and redeemed prescriptions was higher among patients with pre-existing multimorbidity.
CONCLUSIONS: Among patients who underwent LVAD implantation, health care utilization was high in the early post-LVAD discharge phase and was influenced by socio-economic position. Multimorbidity influenced the number of in-hospital days and redeemed prescriptions during the 2 year follow-up.