Estancia prolongada en pacientes ingresados por insuficiencia cardiaca aguda en la Unidad de Corta Estancia (estudio EPICA-UCE): factores asociados / Prolonged hospitalization in patients admitted for acute heart failure in the short stay unit (EPICA-UCE study): Study of associated factors
Med. clín (Ed. impr.)
; 143(6): 245-251, sept. 2014. tab, ilus
Article
in Spanish
| IBECS
| ID: ibc-126844
Responsible library:
ES1.1
Localization: BNCS
RESUMEN
Fundamento y objetivo:
Estudiar los factores asociados con una estancia prolongada de los pacientes ingresados por insuficiencia cardiaca aguda (ICA) en las unidades de corta estancia (UCE) españolas. Pacientes ymétodo:
Estudio de cohorte multipropósito y multicéntrico, con seguimiento prospectivo, que incluyó a todos los pacientes ingresados por ICA en las 11 UCE del registro EAHFE. Se recogieron variables demográficas, antecedentes personales, situación basal cardiorrespiratoria y funcional, datos del episodio de urgencias, del ingreso y del seguimiento a 60 días. La variable resultado fue la estancia prolongada en la UCE (mayor de 72 h). Se utilizó un modelo de regresión logística para controlar los efectos de los factores de confusión.Resultados:
Se incluyeron 819 pacientes, con una edad media (DE) de 80,9 (8,4) años; 483 (59,0%) eran mujeres. La mediana de estancia fue de 3 días (intervalo intercuartílico 2,0-5,0), y la mortalidad intrahospitalaria del 2,7%. Fueron factores independientes asociados a una estancia prolongada, la coexistencia de enfermedad pulmonar obstructiva crónica (odds ratio [OR] 1,56, intervalo de confianza del 95% [IC 95%] 1,02-2,38; p = 0,040) y anemia (OR 1,72, IC 95% 1,21-2,44; p = 0,002), una saturación de oxígeno basal a la llegada a urgencias < 90% (OR 2,21, IC 95% 1,51-3,23; p < 0,001), una crisis hipertensiva como factor precipitante de la ICA (factor protector, OR 0,49, IC 95% 0,26-0,93; p = 0,028) e ingresar en jueves (OR 1,90, IC 95% 1,19-3,05; p = 0,008). No hubo diferencias significativas entre ambos grupos respecto a la mortalidad intrahospitalaria (2,4 frente a 3,0%), mortalidad (4,1 frente a 4,2%) ni revisita a 60 días (18,4 frente a 21,6%).Conclusiones:
En los pacientes con ICA que ingresan en la UCE, se tienen que considerar factores como la presencia de crisis hipertensiva, insuficiencia respiratoria, anemia, antecedente de enfermedad pulmonar obstructiva crónica, e ingresar un jueves para evitar hospitalizaciones prolongadas (AU)ABSTRACT
Background and objective:
To study the factors associated with prolonged hospitalization in patients admitted for acute heart failure (AHF) in Spanish short-stay units (SSUs). Patients andmethods:
This was a multicentre, multipurpose cohort study with prospective follow-up including all patients admitted for AHF in the 11 SSUs of the EAHFE registry. Demographic data, previous illness, baseline cardiorespiratory and functional status, acute episode and admission and follow up variables at 60 days were recorded. The primary outcome was prolonged hospitalization in the SSU (> 72 h). A logistic regression model was used to control the effects of confounding factors.Results:
Eight-hundred and nineteen patients were included with a mean age of 80.9 (SD 8.4) years, 483 (59.0%) being women. The median length stay was 3.0 (IQR 2.0-5.0) days with an in-hospital mortality of 2.7%. The independent factors associated with prolonged hospitalization were the coexistence of chronic obstructive pulmonary disease (odds ratio [OR] 1.56; 95% IC 1.02-2.38; P = .040) and anaemia (OR 1.72; 95% CI 1.21-2.44; P = .002), basal oxygen saturation < 90% on arrival to the Emergency Department (OR2.21, 95% CI 1.51-3.23; P < .001), hypertensive episode as the precipitating factor of the AHF (protective factor OR 0.49; 95% CI 0.26-0.93; P = .028) and admission on Thursday (OR 1.90; 95% CI 1.19-3.05; P = .008). There were no significant differences between both groups regarding to in-hospital mortality (2.4 vs. 3.0%), mortality (4.1 vs. 4.2%) or revisit at 60 days (18.4 vs. 21.6%).Conclusions:
Several factors including hypertensive episode, insufficiency respiratory, anaemia, chronic obstructive pulmonary disease, and admission on Thursday should be taken into account in patients with AHF admitted in SSU stay to avoid prolonged hospitalization (AU)
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Collection:
National databases
/
Spain
Health context:
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Arterial Hypertension
/
Cardiovascular Disease
/
Chronic Obstructive Pulmonary Disease (COPD)
/
Other circulatory Diseases
/
Other Respiratory Diseases
Database:
IBECS
Main subject:
Pulmonary Disease, Chronic Obstructive
/
Heart Failure
/
Hypertension
/
Anemia
Type of study:
Controlled clinical trial
/
Etiology study
/
Incidence study
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Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
Language:
Spanish
Journal:
Med. clín (Ed. impr.)
Year:
2014
Document type:
Article
Institution/Affiliation country:
Hospital Clínic/España
/
Hospital Clínico San Carlos Madrid/España
/
Hospital Clínico San Carlos/España
/
Hospital Doctor Peset/España
/
Hospital General Universitario de Alicante/España
/
Hospital La Fe/España
/
Hospital Marqués de Valdecilla/España
/
Hospital Reina Sofía/España
/
Hospital Universitari Parc Taulí/España
/
Hospital Universitari de Bellvitge/España