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Evolução e caracterização dos reinternamentos nos doentes com insuficiência cardíaca em Portugal Continental entre 2008 e 2017
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Introdução: Das doenças do aparelho circulatório, a insuficiência cardíaca (IC) destaca-se como uma das principais fontes de produção hospitalar e detém a mais elevada taxa de mortalidade intra-hospitalar. Com o aumento da prevalência da IC, a frequência de internamentos e reinternamentos é diretamente impactada com sérias implicações prognósticas, económicas e assistenciais. O objetivo deste trabalho é analisar a evolução dos reinternamentos e caracterizar os doentes adultos com IC reinternados em Portugal Continental, entre 2008 e 2017.
Metodologia: Realizou-se um estudo quantitativo, observacional e longitudinal cuja fonte de dados foi a Base de Dados de Morbilidade Hospitalar. Foi calculado o número total de reinternamentos por ano, tempo decorrido até ao primeiro reinternamento e frequência de reinternamentos por utente. Foi feita uma caracterização demográfica e clínica dos utentes reinternados e análise de associação entre variáveis demográficas e clínicas dos utentes e a probabilidade de reinternamento.
Resultados: Entre 2008-2017 foram registados 184 783 reinternamentos em 11 896 utentes (26,9% do total de internamentos) com um aumento de 36,2%. A maioria dos reinternamentos ocorreu até 90 dias após a alta, sobretudo durante os primeiros 30 dias. A maior parte dos utentes teve 1 reinternamento por ano, com aumento anual da proporção de utentes com 2 e 3 reinternamentos. A maioria dos utentes reinternados era do género feminino (54,2%), com residência nos distritos de Lisboa e Porto e idade média de 78,3 anos. As comorbilidades mais frequentes foram a HTA e a FA, com aumento da prevalência no período em estudo. O ano de internamento, a idade, o distrito de residência e as comorbilidades FA, DMT2 e DPOC associaram-se significativamente com a probabilidade de reinternamento.
Conclusão: Os reinternamentos nos utentes com IC representam uma parte significativa do total de internamentos, com uma tendência de crescimento. Considerando o peso dos reinternamentos a 30 dias e o perfil dos utentes reinternados, são necessárias abordagens multidisciplinares e integradas para quebrar a tendência observada. Este estudo permitiu conhecer melhor o impacto da IC a nível hospitalar e pode servir de suporte ao planeamento de estratégias que tenham como objetivo a redução dos reinternamentos, com consequente impacto positivo organizacional e económico.
Introduction: Out of the diseases of the circulatory system, heart failure (HF) stands out as one of the main sources of hospital production and has the highest in-hospital mortality rate. With the increase in HF prevalence, the frequency of hospitalizations and readmissions is directly impacted with serious prognostic, economic and care implications. The aim of this study is to analyze the evolution of readmissions and characterize adult patients with HF who were readmitted in mainland Portugal, between 2008 and 2017. Methods: A quantitative, observational and longitudinal study was carried out using the inpatient discharge data set. Total number of readmissions per year, time elapsed until the first readmission and frequency of readmissions per patient was calculated. Demographic and clinical characteristics were analyzed to understand readmitted patients profile and to explore their association with the occurrence of readmission. Results: From 2008 to 2017, 184 783 readmissions were registered in 117 896 patients (26.9% of total hospitalizations) witch corresponded to an increase of 36.2%. Most readmissions occurred up to 90 days after discharge, mainly readmissions up to 30 days. Most patients had 1 readmission per year and the proportion of patients with 2 and 3 readmissions increased. The majority of readmitted patients were female (54.2%), with residency in the districts of Lisbon and Porto and an average age of 78.3 years. Most frequent comorbidities were HTN and AF, which prevalence increased during the study period. Year of readmission, age, district of residence and comorbidities AF, T2DM and COPD were associated with the chance of readmission. Conclusion: Readmissions in HF patients represent a significant burden with a growth trend between 2008-2017. Considering the weight of readmissions at 30 days after discharge and the HF readmitted patients profile, multidisciplinary approaches are needed. This study allowed a better understanding of the HF impact at the hospital level and can support the planning of strategies aiming to prevent readmissions, with a positive organizational and economic impact.
Introduction: Out of the diseases of the circulatory system, heart failure (HF) stands out as one of the main sources of hospital production and has the highest in-hospital mortality rate. With the increase in HF prevalence, the frequency of hospitalizations and readmissions is directly impacted with serious prognostic, economic and care implications. The aim of this study is to analyze the evolution of readmissions and characterize adult patients with HF who were readmitted in mainland Portugal, between 2008 and 2017. Methods: A quantitative, observational and longitudinal study was carried out using the inpatient discharge data set. Total number of readmissions per year, time elapsed until the first readmission and frequency of readmissions per patient was calculated. Demographic and clinical characteristics were analyzed to understand readmitted patients profile and to explore their association with the occurrence of readmission. Results: From 2008 to 2017, 184 783 readmissions were registered in 117 896 patients (26.9% of total hospitalizations) witch corresponded to an increase of 36.2%. Most readmissions occurred up to 90 days after discharge, mainly readmissions up to 30 days. Most patients had 1 readmission per year and the proportion of patients with 2 and 3 readmissions increased. The majority of readmitted patients were female (54.2%), with residency in the districts of Lisbon and Porto and an average age of 78.3 years. Most frequent comorbidities were HTN and AF, which prevalence increased during the study period. Year of readmission, age, district of residence and comorbidities AF, T2DM and COPD were associated with the chance of readmission. Conclusion: Readmissions in HF patients represent a significant burden with a growth trend between 2008-2017. Considering the weight of readmissions at 30 days after discharge and the HF readmitted patients profile, multidisciplinary approaches are needed. This study allowed a better understanding of the HF impact at the hospital level and can support the planning of strategies aiming to prevent readmissions, with a positive organizational and economic impact.
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Saúde pública Insuficiência cardíaca Reinternamento Comorbilidades GDH