단일 상급종합병원에서 다학제 심부전 집단 교육이 심부전 환자의 재입원에 미치는 영향 평가
Effect of Multidisciplinary Group Education on Re-Admission of Patients with Heart failure in a Tertiary Hospital
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Background : Previous studies have reported that appropriate self-management of patients with heart failure (HF) through multidisciplinary education can reduce the risk of re-admission. This study aimed to evaluate the effect of multidisciplinary group education, including pharmacists, on re-admission of patients with HF. Methods : This propensity score-matched retrospective cohort study included patients aged ≥65 years with LVEF ≤ 49% who were discharged from the hospital after being hospitalized for HF from January 2019 to June 2021. Patients were divided into an education group that completed HF group education and a usual care group that did not complete such education. The association between multidisciplinary group education and read mission in patients with HF was evaluated using multivariate Cox proportional hazard regression analysis. Risks are presented as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results : After PS matching, the distribution between the two groups became similar for all baseline characteristics except for the use of sacubitril/valsartan (p=0.029). The incidence of readmission owing to HF within 90 days after discharge was significantly lower in the education group than in the usual care group (4.8% vs. 14.3%, p=0.039). There was no significant difference in the risk of all-cause re-admission between the two groups. Moreover, the Cox regression model showed that the risk of HF-associated read mission within 90 days after discharge was significantly lower in the education group than in the usual care group (adjusted HR: 0.32, 95% CI: 0.09-0.90). The risk of all-cause re-admission was not significantly different between the two groups. Conclusion : Multidisciplinary group education in patients with HF demonstrates its importance for patient’s prognosis by reducing HF-associated re-admission within 90 days after discharge. However, additional large-scale prospective studies are needed considering limitations of this study.
Abstract
Background : Previous studies have reported that appropriate self-management of patients with heart failure (HF) through multidisciplinary education can reduce the risk of re-admission. This study aimed to evaluate the effect of multidisciplinary group education, including pharmacists, on re-admission of patients with HF. Methods : This propensity score-matched retrospective cohort study included patients aged ≥65 years with LVEF ≤ 49% who were discharged from the hospital after being hospitalized for HF from January 2019 to June 2021. Patients were divided into an education group that completed HF group education and a usual care group that did not complete such education. The association between multidisciplinary group education and read mission in patients with HF was evaluated using multivariate Cox proportional hazard regression analysis. Risks are presented as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results : After PS matching, the distribution between the two groups became similar for all baseline characteristics except for the use of sacubitril/valsartan (p=0.029). The incidence of readmission owing to HF within 90 days after discharge was significantly lower in the education group than in the usual care group (4.8% vs. 14.3%, p=0.039). There was no significant difference in the risk of all-cause re-admission between the two groups. Moreover, the Cox regression model showed that the risk of HF-associated read mission within 90 days after discharge was significantly lower in the education group than in the usual care group (adjusted HR: 0.32, 95% CI: 0.09-0.90). The risk of all-cause re-admission was not significantly different between the two groups. Conclusion : Multidisciplinary group education in patients with HF demonstrates its importance for patient’s prognosis by reducing HF-associated re-admission within 90 days after discharge. However, additional large-scale prospective studies are needed considering limitations of this study.
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