指南-转诊标准和转诊到专门心力衰竭诊所的门诊患者的风险概况

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-02-01 DOI:10.1016/j.cjco.2024.11.006

Isabelle J. Tan HBSc , Batol Barodi MGA , Tayler A. Buchan PhD(c) , Lakshmi Kugathasan PhD , Michael McDonald MD , Heather Ross MD, MHSc , Ana C. Alba MD, PhD

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引用次数: 0

摘要

背景：专门的心力衰竭（HF）护理可改善心力衰竭患者的预后。为了了解转诊到专科诊所的心衰门诊患者的风险概况，我们评估了转诊原因，预测了风险，并在一家大型心衰专科诊所评估了指南推荐的转诊标准。方法：我们进行了一项横断面研究，纳入了2021年11月至2022年11月转诊的HF（≥18岁）门诊患者。我们使用西雅图心力衰竭模型（SHFM）和I-NEED-HELP转诊标准计算1年预测死亡率。我们通过Kruskal-Wallis、Wilcoxon秩和、卡方和Fisher精确检验比较shfm预测的中位死亡率与转诊原因和I-NEED-HELP标准。结果纳入的245例连续HF门诊患者中，shfm预测的1年死亡率中位数为4%（四分位数间距[IQR] 2%-8%）。转诊原因包括先进治疗评估（29%）、药物优化（23%）、诊断评估（19%）、住院后/急诊科就诊（14%）、持续的心衰管理（12%）、患者要求（2%）和转至成人护理（1%）。shfm预测的1年死亡率中位数因转诊原因而无显著差异（P = 0.11），但在满足任何（5%,IQR 3%-9%）与不满足（3%,IQR 2%-5%） I-NEED-HELP标准的患者中差异显著(P <；0.001)。在转诊原因中，任何I-NEED-HELP标准的存在差异显著(P <；0.001);大多数接受高级治疗评估（96%）和诊断评估（94%）的患者至少满足1项标准。结论到专门的心衰门诊就诊的患者风险范围较大。满足任何I-NEED-HELP标准与不满足I-NEED-HELP标准的患者预测死亡率的差异在临床上似乎不显著。在转诊时结合模型预测的风险可以指导分诊和患者优先排序。

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Guideline-Referral Criteria and Risk Profiles of Outpatients Referred to a Specialised Heart Failure Clinic

Background

Specialised heart failure (HF) care improves outcomes for patients with HF. To understand the risk profiles of HF outpatients referred to a specialised clinic, we evaluated referral reasons, predicted risk, and the presence of guideline-recommended referral criteria at a large specialised HF clinic.

Methods

We conducted a cross-sectional study including outpatients with HF (≥ 18 years old) referred from November 2021 to November 2022. We calculated 1-year predicted mortality with the use of the Seattle Heart Failure Model (SHFM) and the I-NEED-HELP referral criteria. We compared median SHFM-predicted mortality with referral reasons and the I-NEED-HELP criteria by means of Kruskal-Wallis, Wilcoxon rank-sum, chi-square, and Fisher exact tests.

Results

Among 245 consecutive HF outpatients included, median SHFM-predicted 1-year mortality was 4% (interquartile range [IQR] 2%-8%). Reasons for referral included evaluation for advanced therapies (29%), medication optimisation (23%), diagnostic evaluation (19%), post-hospitalisation/emergency department visit (14%), ongoing HF management (12%), patient request (2%), and transition to adult care (1%). The median SHFM-predicted 1-year mortality did not differ significantly by referral reason (P = 0.11) but differed significantly among patients meeting any (5%, IQR 3%-9%) vs no (3%, IQR 2%-5%) I-NEED-HELP criteria (P < 0.001). Across referral reasons, the presence of any I-NEED-HELP criteria differed significantly (P < 0.001); most patients referred for advanced therapies evaluation (96%) and diagnostic evaluation (94%) met at least 1 criterion.

Conclusions

Patients referred to a specialised HF clinic have a wide risk range. The difference in predicted mortality among patients meeting any vs no I-NEED-HELP criteria appears clinically insignificant. Incorporating model-predicted risk at the time of referral can guide triage and patient prioritisation.

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