Multilevel model analysis for influencing factors of readmission in coronary heart disease patients with heart failure / 中华疾病控制杂志

ABSTRACT

Objective To explore the influencing factors of readmission in coronary heart disease patients with heart failure by constructing a multilevel Cox regression model. Methods A total of 1 433 coronary heart disease patients with heart failure were consecutively enrolled, from two hospitals in Shanxi Province from January, 2014 to December, 2017. Patients’ medical records (including baseline data, examination and treatment) were recorded and patients were followed up. The median follow-up period was 23 months. Univariate Cox regression analysis and mutivariate Cox regression analysis were used to screen the independent variables. Two-level Cox regression model was used to analyze the influencing factors. Results Rehospitalization occurred in 436(30.4%) cases. Two-level Cox regression model showed that advanced age(HR=1.010, 95% CI1.001-1.019, P=0.032), male(HR=1.234, 95% CI 1.009-1.509, P=0.040), physical labor(HR=1.458, 95% CI 1.036-2.050, P=0.030),urban medical insurance (HR=1.513, 95% CI 1.120-2.043, P=0.007), and prolonged QRS interval (HR=1.004, 95% CI1.001-1.008, P=0.018) were independent risk factors for readmission coronary heart disease patients with heart failure. High urine specific gravity(HR=0.000, 95% CI0.000-0.059, P=0.021) was a protective factor. Conclusions The age, gender, occupation, urban medical insurance, QRS intervall, and urine specific gravity are influencing factors of readmission in coronary heart disease patients with heart failure. Strengthening clinical nursing and monitoring and perfecting social security system can reduce the occurrence of patients’ rehospitalization.