Admission under general medicine versus cardiology for heart failure showed no significant difference in days-alive-and-out-of-hospital at 90 days (coefficient -5.36; 95% CI -11.73 to 1.01; P=0.099).
Observational (n=4,913)
Yes
Does admission under general medicine compared to cardiology affect days-alive-and-out-of-hospital and mortality in hospitalized heart failure patients?
After adjusting for frailty and other characteristics, clinical outcomes for heart failure patients are similar whether admitted under general medicine or cardiology.
Effect estimate: coefficient -5.36 (95% CI -11.73 to 1.01)
p-value: p=0.099
BACKGROUND: Previous studies have reported differing clinical outcomes among hospitalized heart failure (HF) patients admitted under cardiology and general medicine (GM) without consideration of patients' frailty. AIMS: To explore outcomes in patients admitted under the two specialities after taking into account their frailty and other characteristics. METHODS: This retrospective study included all HF patients ≥18 years admitted between 1 January 2013 and 31 December 2019 at two Australian tertiary hospitals. Frailty was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥ 5 were classified as frail. Propensity score matching (PSM) was used to match 11 variables between the two specialities. The primary outcomes included the days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge, 30-day mortality and readmissions. RESULTS: Of 4913 HF patients, mean age 76.2 (14.1) years, 51% males, 2653 (54%) were admitted under cardiology compared to 2260 (46%) under GM. Patients admitted under GM were more likely to be older females, with a higher Charlson index and poor renal function than those admitted under cardiology. Overall, 23.8% patients were frail and frail patients were more likely to be admitted under GM than cardiology (33.6% vs. 15.3%, P < 0.001). PSM created 1532 well-matched patients in each group. After PSM, the DAOH90 was not significantly different among patients admitted in GM when compared to cardiology (coefficient -5.36, 95% confidence interval -11.73 to 1.01, P = 0.099). Other clinical outcomes were also similar between the two specialities. CONCLUSIONS: Clinical characteristics of HF patients differ between GM and cardiology; however, clinical outcomes were not significantly different after taking into account frailty and other variables.
Sharma等人（星期二）在心力衰竭方面进行了一项观察性研究（n=4,913）。在出院90天时评估普通医学与心脏病学住院患者的生存天数和出院天数（DAOH90）（系数-5.36，95% CI -11.73到1.01，p=0.099）。心力衰竭患者在普通医学与心脏病学住院之间在90天的生存天数和出院天数没有显著差异（系数-5.36；95% CI -11.73到1.01；P=0.099）。