Factores asociados a estancias cortas en los pacientes ingresados por insuficiencia cardiaca aguda / Factors associated with short stays for patients admitted with acute heart failure
Emergencias (St. Vicenç dels Horts)
; 28(6): 366-374, dic. 2016. graf, tab
Artigo
em Espanhol
| IBECS
| ID: ibc-158776
Biblioteca responsável:
ES1.1
Localização: BNCS
RESUMEN
OBJETIVO:
Identificar factores asociados a un tiempo de estancia hospitalaria (TDEH) corto en pacientes ingresados por insuficiencia cardiaca aguda (ICA) en hospitales con unidad de corta estancia (UCE).MÉTODO:
Estudio de cohorte multipropósito y multicéntrico no intervencionista, con seguimiento prospectivo de pacientes con ICA ingresados en 10 hospitales españoles con UCE. Se recogieron variables demográficas, antecedentes personales, situación basal cardiorrespiratoria y funcional, de urgencias, del ingreso y de seguimiento a 30 días. La variable resultado fue un TDEH corto (_ 4 días). Se realizaron curvas de rendimiento diagnóstico (ROC) de modelos simples y mixtos predictivos de TDEH corto y se calculó el área bajo la curva (ABC) de la característica operativa del receptor (COR).RESULTADOS:
Se incluyeron 1.359 pacientes con una edad 78,7 (DE 9,9) años, el 53,9% mujeres, 568 (41,8%) tuvieron un TDE de 4 o menos días. Ingresaron 590 pacientes (43,4%) en UCE y 769 (56,6%) en salas de hospitalización convencional. En el modelo de regresión mixto ajustado al centro, la crisis hipertensiva (OR 1,79, IC 95% 1,17-2,73; p = 0,007) y el ingresar en UCE (OR 16,6, IC95% 10,0-33,3; p < 0,001) se asociaron a TDEH corto, y la ICA hipotensiva (OR 0,49, IC 95% 0,26-0,91; p = 0,025), la hipoxemia, (OR 0,68, IC 95% 0,53-0,88; p = 0,004) e ingresar en miércoles, jueves o viernes (OR 0,62, IC 95% 0,49-0,77; p < 0,001) a TDEH largo. El ABC COR del modelo mixto ajustada al centro fue 0,827 (IC 95% 0,80-0,85; p < 0,001). La mortalidad a 30 días y el reingreso a 30 días no difirieron entre ambos grupos (0,5% frente a 0,5%, p = 0,959; y 22,9% frente a 27,7%, p = 0,059, respectivamente).CONCLUSIONES:
En pacientes con ICA existen factores clínicos y organizativos en cada centro que se relacionan de forma independiente con un TDEH corto, entre los que destaca el tener una UCEABSTRACT
OBJECTIVE:
To identify factors associated with short hospital stays for patients admitted with acute heart failure (AHF) admitted to hospitals with short-stay units (SSU).METHODS:
Multicenter nonintervention study in a multipurpose cohort of patients with AHF to 10 Spanish hospitals with short-stay units; patients were followed prospectively. We recorded demographic data, medical histories, baseline cardiorespiratory and function variables on arrival in the emergency department, on admission, and at 30 days. The outcome variable was a short hospital stay (_ 4 days). We built receiver operating characteristic curves of simple and mixed predictive models for short stays and calculated the area under the curves.RESULTS:
A total of 1359 patients with a mean (SD) age of 78.7 (9.9) years (53.9% women) were included; 568 (41.8%) had short stays. Five hundred ninety patients (43.4%) were admitted to SSU and 769 (56.6%) were admitted to conventional wards. The variables associated with a short-stay according to the mixed regression model were hypertensive crisis (odds ratio [OR], 1.79; 95% CI, 1.17-2.73; P=.007) and admission to a SSU (OR, 16.6; 95% CI, 10.0-33.3; P<.001). Hypotensive AHF (OR, 0.49; 95% CI, 0.26-0.91; P=.025), hypoxemia (OR, 0.68; 95% CI, 0.53-0.88; P=.004); and admission on a Wednesday, Thursday, or Friday (OR, 0.62; 95% CI, 0.49-0.77; P<.001) were associated with a long stay. The area under the receiver operating characteristic curve was 0.827 (95% CI, 0.80-0.85; P<.001). Thirty-day mortality and readmission rates did not differ between patients with short vs long stays (mortality, 0.5% in both cases, P=.959; and readmission, 22.9% vs 27.7%, respectively; P=.059).CONCLUSION:
Both clinical and administrative factors are independently related to whether patients with AHF have short stays in the hospitals studied, and among therapy, it is remarkable the existence of a SSU
Texto completo:
Disponível
Coleções:
Bases de dados nacionais
/
Espanha
Base de dados:
IBECS
Assunto principal:
Tratamento de Emergência
/
Insuficiência Cardíaca
Tipo de estudo:
Ensaio clínico controlado
/
Estudo observacional
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Estudo prognóstico
/
Fatores de risco
Limite:
Humanos
Idioma:
Espanhol
Revista:
Emergencias (St. Vicenç dels Horts)
Ano de publicação:
2016
Tipo de documento:
Artigo
Instituição/País de afiliação:
Hospital Clínic/España
/
Hospital Clínico San Carlos/España
/
Hospital General Universitario de Alicante/España
/
Hospital La Fe/España
/
Hospital Marqués de Valdecilla/España
/
Hospital Peset/España
/
Hospital Reina Sofía/España
/
Hospital Sant Pau/España
/
Hospital Universitari de Bellvitge/España
/
Hospital Universitario Central de Asturias/España