A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure

Sung

et al. 2017

JAHA

204

208

BackgroundNutritional status has been related to clinical outcomes in patients with heart failure. We assessed the association between nutritional status, indexed by prognostic nutritional index (PNI), and survival in patients hospitalized for acute heart failure.Methods and ResultsA total of 1673 patients (age 76±13 years, 68% men) hospitalized for acute heart failure in a tertiary medical center were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm3). National Death Registry was linked to identify the clinical outcomes of all‐cause and cardiovascular death. With increasing tertiles of PNI, age and N‐terminal probrain natriuretic peptide decreased, and body mass index, estimated glomerular filtration rate, and hemoglobin increased. During a mean follow‐up duration of 31.5 months, a higher PNI tertile was related to better survival free from all‐cause and cardiovascular mortality in the total study population and in participants with either reduced or preserved left ventricular ejection fraction. After accounting for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, serum sodium level, and on‐admission systolic blood pressure, PNI was independently associated with cardiovascular death and total mortality (hazard ratio per 1 SD of the natural logarithm of the PNI: 0.76 [95% CI, 0.66–0.87] and 0.79 [95% CI, 0.73–0.87], respectively). In subgroup analyses stratified by age, sex, left ventricular ejection fraction, body mass index, or estimated glomerular filtration rate, PNI was consistently related to mortality.Conclusions PNI is independently associated with long‐term survival in patients hospitalized for acute heart failure with either reduced or preserved left ventricular ejection fraction.

Section: Discussionmentioning

confidence: 99%

Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure

Sung

et al. 2017

JAHA

204

208

“…Seven randomized trials in the United States whose enrollees averaged from 65 to 76 years identified or recruited patients as inpatients, sometimes with the requirement that they be at least 70 years old. [22][23][24][25] Current or recent inpatients and their families may be more likely to agree to participate, perhaps because they feel more at risk of the condition's complications and more open to approaches to reduce that risk.…”

Section: Discussionmentioning

confidence: 99%

The success of recruiting minorities, women, and elderly into a randomized controlled effectiveness trial

Sisk

Horowitz

Wang

et al. 2008

Mount Sinai J Medicine

Background-Heart failure, a leading cause of hospitalization among elderly people, disproportionately afflicts African-American and other non-White populations. Studies of health care interventions often do not include these groups in proportion to numbers in the patient population. Our objective was to assess whether a randomized controlled effectiveness trial enrolled patients by ethnicity/race, gender, and age in proportion to those eligible.

“…8 Studies show that comprehensive discharge planning, including medication counseling and review along with increased communication and follow-up, can help reduce readmissions. 9 In addition, the use of implantable cardiac devices combined with optimal medical therapy has successfully reduced hospitalization rates for patients with HF. 10 Many prior studies on readmission rates have been limited to single-center experiences over a period of several years.…”

Section: Introductionmentioning

confidence: 99%

Current trends in heart failure readmission rates: analysis of medicare data

Aranda

Johnson

Conti

2009

Clinical Cardiology

100

Background: Despite advances in optimal pharmacologic therapy, patients with heart failure (HF) continue to have significant rehospitalization rates. Hypothesis: We sought to provide current estimates on rates of readmission for Medicare patients with HF, and identify factors associated with an increased chance of readmission. Methods: We used Medicare data from the 5% sample Standard Analytical File Limited Data Set for the years 2002 through 2004 to calculate readmission rates for HF. Clinical factors associated with readmission rates were identified using multivariate logistic regression. Results: We identified 28,919 patients accounting for 38,849 HF hospitalizations in the 5% sample for 2003. These numbers project to an estimated 578,380 patients with 776,980 HF hospitalizations. In-hospital mortality was 4.4% with an average length of stay of 5.5±5.4 d. In the 6-9 mo following the initial HF admission, 60% of patients had 1 or more readmissions for any cause. Heart failure accounted for 28% of all readmissions. Factors associated with readmission for HF after the initial HF hospitalization included age <65 y, geographic location, previous hospitalization, length of stay of initial HF hospitalization >7 d, not receiving a cardiac device implant at the time of initial HF hospitalization, and history of comorbidities including diabetes, myocardial infarction, peripheral vascular disease, and stroke. Conclusions: Medicare patients with HF continue to have significant morbidity and one of the highest inhospital mortality rates of any HF patient population. Factors associated with worse outcomes after an initial HF hospitalization can be used to identify patients who require aggressive therapy and follow-up.