Análisis poblacional de las hospitalizaciones por insuficiencia cardiaca en la Región de Murcia 2003-2013tendencias, reingresos y pronóstico

Abstract

OBJECTIVE To provide current data by studying the trends and evolution of hospitalization, readmissions and survival of patients with heart failure (HF) in the Region of Murcia during the years 2003 to 2013. METHODOLOGY Observational and historical cohort study, based on the Minimum Basic Data Set, which includes all hospitals in the Region of Murcia. and are publicly funded. All hospitalizations with a principal diagnosis of HF between 2003 and 2013 were obtained. “Health care episodes” were created by grouping together the discharges showing continuity of care (transfers between hospitals), identifying people through the code of their Individual Health Card with a main diagnosis of HF until 2015. An analysis of temporary trends in hospitalization and early readmissions at 30 days after discharge (unplanned) by Joinpoint regression, a comparison was made between in-hospital mortality and mortality in the readmission. The main associated comorbidities and the Elixhauser index were described. On the other hand, people with a first diagnosis at the hospital discharge of HF, "incidents or new" in the period 2009-2013 (who did not have CI income at least from 2002) were studied and compared with those who presented previous "recurrent" HF. Population and trend rates were calculated by Joinpoint regression. The survival of these two cohorts was also calculated from 2009 to 2015 and compared with the overall survival of the Spanish population. Finally, the chronology of readmissions regarding death and its causes (due to HF, cardiovascular or for any reason) was evaluated.   RESULTS During the period studied (2003 - 2013), 27,158 episodes caused by 16,827 people (1.62 per person) were identified, producing 2.26 discharges per 1,000 inhabitants with a predominance of females (57.3%) and those over 75 years of age. Rates doubled in persons > 75 years, reaching 19.9% in those aged 75 to 84 years (APC, 5.4%) and 32.5% in those aged 85 years (APC, 11.7%) but were unchanged in persons aged < 75 years. The average stay was 9.4 days and in-hospital mortality was 9.2%. The Elixhauser index increased by almost one point during the period, and hipertension, diabetes, atherosclerosis and dyslipidemia were present in 46.2%, 36.7%, 32.3% and 30.8% of the discharges. The analysis of Joinpoint showed an increased rate of the frequentation with a change in the 2007 (percentage of annual change [PCA] = 8,16%, p <0,05 to 1,88%, p <0,05 from of 2007) and 30-day unplanned readmissions (PCA = 1.36%; p <0.05), which were mainly concentrated in the first days after hospital discharge with a peak on the fourth day after discharge (+ 13.29%) due to causes other than the HF. A statistically significant higher mortality was observed in readmissions at 30 days (12.5% with respect to hospitalization index 9.2% p <0.001), and up to a third of these were due to a new episode of HF. Age and burden of comorbidity were the main predictors of any readmission. We identified 8,258 incidents, with an increasing trend of the annual rate (+ 2.3%, p <0.05) representing 1.24 per thousand inhabitants. In the first year, 22% re-admissions were due to HF, 31% due to cardiovascular causes and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sexadjusted expected survival for the general population (76%) (P < .001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a ‘‘J’’ pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death.