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Circulation:心力衰竭患者急救后及时复诊可降低死亡率

来源:新华社 2011-06-21 14:17

加拿大最新研究发现,心力衰竭患者在急救中心紧急救治后,如果及时复诊可降低死亡率。

研究人员分析了从2004年4月至2007年3月间在加拿大安大略省被紧急送到急救中心的1万多名心力衰竭患者的数据。结果发现,20%的心力衰竭患者在急救中心经紧急救治返家后,30天内没再去看医生。结果这些患者再次被送到急救中心或住院的可能性很高,一年内死亡的几率也更大。

参与这项研究的加拿大临床评估科学研究所的道格拉斯·李博士说:“心力衰竭是一种致命疾病。住院治疗会花掉大笔费用。如果在30天内去看医生就可有助免除住院治疗和再次急救,降低死亡率,这样做很有价值。”

这项研究发表在新一期《循环》杂志上。(生物谷Bioon.com)

生物谷推荐原文出处:

Circulation   DOI:10.1161/CIRCULATIONAHA.110.940262

Improved Outcomes With Early Collaborative Care of Ambulatory Heart Failure Patients Discharged From the Emergency Department

Douglas S. Lee, MD, PhD; Thérèse A. Stukel, PhD; Peter C. Austin, PhD; David A. Alter, MD, PhD; Michael J. Schull, MD, MSc; John J. You, MD, MSc; Alice Chong, BSc; David Henry, MBChB; Jack V. Tu, MD, PhD

Background— The type of outpatient physician care after an emergency department visit for heart failure may affect patients' outcomes.

Methods and Results— Using the National Ambulatory Care Reporting System, we examined the care and outcomes of heart failure patients who visited and were discharged from the emergency department in Ontario, Canada (April 2004 to March 2007). Early collaborative care by a cardiologist and primary care (PC) physician within 30 days after discharge was compared with PC alone. Care for 10 599 patients (age, 74.9±11.9 years; 50.2% male) was provided by PC alone (n=6596), cardiologist alone (n=535), or concurrently by both cardiologist and PC (n=1478); 1990 did not visit a physician. Collaborative care patients were more likely to undergo assessment of left ventricular function (57.4% versus 28.7%), noninvasive stress testing (20.1% versus 7.8%), and cardiac catheterization (11.6% versus 2.7%) compared with PC. Drug prescriptions (patients 65 years of age) demonstrated higher use of angiotensin-converting enzyme inhibitors (58.8% versus 54.6%), angiotensin receptor blockers (22.7% versus 18.1%), β-adrenoceptor antagonists (63.4% versus 48.0%), loop diuretics (84.2% versus 79.6%), metolazone (4.8% versus 3.4%), and spironolactone (19.8% versus 12.7%) within 100 days after emergency department discharge for collaborative care compared with PC. In a propensity-matched model, mortality was lower with PC compared with no physician visit (hazard ratio, 0.75; 95% confidence interval, 0.64 to 0.87; P<0.001). Collaborative care reduced mortality compared with PC (hazard ratio, 0.79; 95% confidence interval, 0.63 to 1.00; P=0.045). Sole cardiology care conferred a trend to increased mortality (hazard ratio, 1.41 versus collaborative care; 95% confidence interval, 0.98 to 2.03; P=0.067).

Conclusions— Early collaborative heart failure care was associated with increased use of drug therapies and cardiovascular diagnostic tests and better outcomes compared with PC alone.

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