{"title":"院外心脏骤停住院患者的姑息治疗咨询：对侵入性程序、拒绝复苏指令和医疗成本的影响。","authors":"Abdilahi Mohamoud, Nadhem Abdallah, Abdirahman Wardhere, Mahmoud Ismayl","doi":"10.1016/j.carrev.2024.08.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status.</p><p><strong>Method: </strong>This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities.</p><p><strong>Results: </strong>Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations.</p><p><strong>Conclusion: </strong>Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs.\",\"authors\":\"Abdilahi Mohamoud, Nadhem Abdallah, Abdirahman Wardhere, Mahmoud Ismayl\",\"doi\":\"10.1016/j.carrev.2024.08.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status.</p><p><strong>Method: </strong>This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities.</p><p><strong>Results: </strong>Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations.</p><p><strong>Conclusion: </strong>Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.</p>\",\"PeriodicalId\":47657,\"journal\":{\"name\":\"Cardiovascular Revascularization Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-08-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Revascularization Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.carrev.2024.08.003\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Revascularization Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.carrev.2024.08.003","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：姑息关怀咨询对院外心脏骤停（OHCA）住院患者的管理和预后的影响仍鲜为人知。本研究探讨了姑息治疗咨询与OHCA住院患者的院内预后之间的关系，并根据生存状况进行了分层：这项横断面研究使用了全国住院病人抽样调查（2016-2021 年）的数据。研究纳入了接受心肺复苏的 OHCA 住院成人患者。多变量分析评估了姑息治疗咨询与非终末期和终末期 OHCA 住院治疗结果之间的关联，并对人口统计学、医院特征和合并症进行了调整：在 488,700 例 OHCA 住院患者中，姑息关怀咨询与非终末期住院患者较低的侵入性程序几率相关，包括经皮冠状动脉介入治疗（PCI）（aOR 0.30，95 % CI 0.25-0.36）、机械循环支持（aOR 0.54，95 % CI 0.44-0.68）、永久起搏器（aOR 0.27，95 % CI 0.20-0.37）、植入式心律转复除颤器（aOR 0.22，95 % CI 0.16-0.31）和心脏复律（aOR 0.62，95 % CI 0.55-0.70）。在末期住院治疗中，姑息治疗与较低的 PCI（aOR 0.78，95 % CI 0.70-0.87）和心脏电复律（aOR 0.91，95 % CI 0.85-0.97）几率相关，但与较高的治疗性低温（aOR 3.12，95 % CI 2.72-3.59）、胃造瘘（aOR 1.22，95 % CI 1.05-1.41）和肾脏替代治疗（aOR 1.19，95 % CI 1.12-1.26）几率相关。姑息治疗与两个亚组中较高的DNR使用率和较低的非终末期住院费用相关，但与较高的终末期住院费用相关：结论：在 OHCA 患者中，姑息治疗咨询与侵入性手术、DNR 使用率和住院费用的差异有关，这些差异因存活状况而异。
Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs.
Background: The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status.
Method: This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities.
Results: Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations.
Conclusion: Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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