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背景根据电子医疗记录,全科医生对心力衰竭患者诊断的正确率有较大差异。本文旨在探究:电子诊疗记录是否有射血分数数据对诊断为心力衰竭患者预后的影响,心力衰竭患者电子诊疗记录中无射血分数数据的原因。方法本研究为基于西班牙巴塞罗那52个社区卫生服务中心的回顾性队列研究,对年龄>40岁且随访5年的8378例心力衰竭患者资料进行了分析。结果仅有8.5%的患者电子病历中有射血分数数据。2009-2012年,患者的累积住院率和病死率共为37.6%。射血分数数据未记录在病历中的患者累积住院率和病死率高于射血分数记录在病历中的患者[HR=1.84,95%CI(1.68,1.95)];有住院史[HR=1.81,95%CI(1.68,1.95)]、需家庭护理[HR=1.58,95%CI(1.46,1.71)]的患者均具有较高的不良结局风险。高龄、社会经济地位差、肥胖、需家庭护理、使用髓袢利尿剂的患者更易出现电子病历未记录射血分数。结论基层医疗中,心力衰竭患者电子病历中无射血分数数据较为普遍,多发生在高龄、社会经济地位差、身体虚弱的患者中,预后较差。
Background According to the electronic medical record, general practitioners have great differences in the accuracy of diagnosis of heart failure patients. The purpose of this article is to investigate whether e-medical records have effects of ejection fraction data on the prognosis of patients diagnosed with heart failure and no ejection fraction data on electronic medical records of patients with heart failure. METHODS: Based on a retrospective cohort study of 52 community health centers in Barcelona, Spain, this study analyzed the data of 8,378 patients with heart failure who were> 40 years of age and were followed up for 5 years. Results Only 8.5% of patients had EUS data on ejection fraction. In 2009-2012, the cumulative hospitalization rate and case fatality rate were 37.6%. Patients with ejection fraction data not recorded in the medical records had higher cumulative hospitalization and mortality rates than those with ejection fractions recorded in the medical records [HR = 1.84, 95% CI (1.68, 1.95)]; hospitalization history [HR = 1.81 , 95% CI (1.68, 1.95)], and patients in need of home care [HR = 1.58,95% CI (1.46,1.71]] had a higher risk of adverse outcomes. Elderly patients, poor socioeconomic status, obesity, home-care needs and patients with diarrhea on medulla oblongata were more likely to have electronic medical records without recording ejection fraction. Conclusions In primary medical care, the data of no ejection fraction in electronic medical records of heart failure patients are more common, which occur frequently in elderly patients with poor socio-economic status and frailty. The prognosis is poor.