Study On Hospital Readmission And Influencing Factors Of Patients With Chronic Heart Failure

Purpose By collecting the relevant data of the readmission of patients with chronic heart failure(CHF)in a local municipal hospital,the single and multiple factors affecting the readmission of CHF patients were analyzed,and the risk factors that may affect the readmission of CHF patients were understood to guide the clinical diagnosis and treatment,so as to reduce the incidence of readmission of patients with CHF.Method Using a retrospective study,CHF patients admitted to the cardiovascular medicine and respiratory department of a local municipal hospital from July 2021 to July 2022 were selected.Collect relevant data on all study subjects: 1.Basic information about hospitalization,Including: gender,age,hospitalization payment method,admission route;2.Basic information at admission,Including: Heart rate(HR),systolic blood pressure(SBP)/ diastolic blood pressure(DBP),the New York Heart Association(NYHA)cardiac function grade,oedema;3.Results of auxiliary examination during hospitalization,Including:(1)Heart-related indicators: N-telencephalic natriuretic peptide precursor(NT-pro BNP),troponin(c Tn)I,creatine kinase(CK),creatine kinase isoenzyme(CK-MB),α-hydroxybutyrate dehydrogenase(α-HBDH),lactate dehydrogenase(LDH),left atrial internal diameter(LAD),left ventricular end-diastolic inner diameter(LVEDD),left ventricular ejection fraction(LVEF);(2)Infection-related indicators: white blood cells(WBC),C-reactive proteins(CRP),procalcitonin(PCT);(3)Metabolism-related indicators: hemoglobin(Hb),fasting blood glucose(FBG),Hb A1 c,total cholesterol(TC),triglycerides(TG),HDL cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C);(4)Electrolytes:serum potassium ion(K+),serum sodium ions(Na+),serum chloride ions(Cl-);(5)Coagulation-related indicators: D-dimer(D-D),blood platelets(PLT);(6)Renal function: blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA);4.Other comorbidities,Including:(1)Combined with other circulatory diseases: hypertension,atrial fibrillation(AF),and other arrhythmia,myocardial infarction(MI);(2)Combined respiratory diseases: pulmonary infectious disease,chronic obstructive pulmonary disease(COPD),sleep apnea-hypopnea syndrome(OSAS),pulmonary space-occupying lesions,bronchiectasis;(3)Combined digestive system diseases:esophagitis,gastritis,liver disease,gastrointestinal bleeding,gastrointestinal ulcer(PU);(4)Urinary system diseases: urinary tract infection,kidney disease;(5)Combined endocrine system disease: thyroid disease,diabetes mellitus(DM).According to whether the study subjects have readmission events within a year,all the study subjects were divided into non-readmission group and readmission group,the relevant data of the two groups of statistical analysis,observe the difference between CHF patients and non-readmission group,and then analyze the risk factors that may affect the readmission of CHF patients.Results From July 2021 to July 2022,a total of 6241 patients were hospitalized in the cardiovascular medicine and respiratory department of a local municipal hospital,of which 1181 were clinically diagnosed with CHF and met the inclusion criteria of this study.1.The number was 779 and 402 in the nonreadmission group,with a prevalence of 34%.The number of deaths in the non-readmission group was 15,with a mortality rate of 1.9%,and 23 in the readmission group and 5.7%,with a significant difference between the two groups(P<0.01).2.There was a significant difference in age between the readmission and non-readmission group(P<0.01),both groups were mostly advanced,and the age of CHF patients in the readmission group was significantly higher than those in the non-readmission group.However,there was no statistical difference between the two groups in gender,admission route,and inpatient payment method.3.There were significant differences between the readmission and non-readmission groups and those reported significantly regarding SBP / DBP(P<0.01).The number of NYHA cardiac grade IV was significantly more than the non-readmitted group,respectively(P<0.01),and the non-readmission group had more cardiac grade II and II-III than the readmitted group,and the two groups were statistically significant(P<0.05).However,there was no statistical difference in HR and oedema.4.The readmitted and non-readmitted groups showed significant differences in cardiac related indicators NT-pro BNP,c Tn I,CK,LAD,LVEDD,LVED,LVEF,metabolic-related indicators Hb,TC,LDL-C,electrolyte K+,Na+,coagulation-related indicators D-D,BUN,Cr,and UA of renal function(P<0.01).There were significant differences in Hb A1 c,TG,and PLT(P<0.05).However,there was no statistical difference in CK-MB,α-HBDH,LDH,WBC,CRP,PCT,FBG,HDL-C,and Cl-on admission.In CHF patients with DM,Hb A1 c was significantly higher than that in the non-readmitted group,with a significant difference between the two groups(P<0.01),while in patients without CHF with DM,there was no significant difference between the readmission group and the non-readmitted group(P>0.05).5.There were significant differences between the readmission and non-readmission groups in combined AF,MI,COPD,and kidney disease(P<0.01),and statistical differences in combined hypertension grade 3 and liver disease(P<0.05).However,there was no statistical difference in combined hypertension,hypertension grade 1,hypertension grade 2,arrhythmia,pulmonary infectious disease,OSAS,pulmonary space-occupying lesions,bronchial asthma,gastritis,esophagitis,gastrointestinal bleeding,PU,urinary tract infection,thyroid disease,and DM(P>0.05).6.For patients with NYHA grade IV in CHF,Hb A1 c in this group was significantly higher than NYHA grade II,whether with DM or not,with significant differences between the two groups(P<0.01).The Spearman correlation analysis showed that Hb A1 c was negatively associated with the severity of HF(LVEF)in CHF patients(r=-0.138,P=0.001).7.Through binary Logistic regression analysis,it was concluded that age,NYHA cardiac function grade IV,LVEDD,LVEF,Hb A1 c,hypertension grade 3,COPD,and kidney disease are independent factors influencing the readmission of patients with heart failure,and had a significant impact on the readmission of patients with heart failure.8.The detection thresholds for age,DBP,LVEDD,LVEF,and Hb A1 c for predicting CHF readmission events were 81 years,80 mm Hg,54.5mm,55.8%,5.4%,respectively.The area under the ROC curve for the combined prediction was 0.776,suggesting that the predictive efficacy of the combined test was higher than age,DBP,LVEDD,LVEF,and Hb A1 c alone.The sensitivity of the combined test was 66.5% and 76.5% specific for CHF patients.Conclusion From this study,it can be concluded that age,SBP/DBP,NYHA grade IV,NT-pro BNP,c Tn I,CK,CK,LAD,LVEDD,LVEF,Hb,Hb A1 c,TC,TG,LDL-C,K+,Na+,BUN,Cr,UA,D-D,PLT,hypertension,AF,MI,COPD,and kidney disease were all associated with readmission of CHF patients to different degrees.Hb A1 c levels were correlated with the degree of heart failure(LVEF)in CHF patients and were inversely correlated.Age,DBP,NYHA cardiac function grade IV,LVEDD,LVEF,Hb A1 c,combined hypertension grade 3,COPD,and renal disease were independent influencing factors affecting readmission in CHF patients and had significant impact on CHF patients.Among them,the combined detection of age,DBP,LVEDD,LVEF,and Hb A1 c can be used as important biological indicators for condition prediction in CHF patients.