Etiologies, Trends, and Predictors of 30-Day Readmissions in Patients With Diastolic Heart Failure

Arora, Shilpkumar; Lahewala, Sopan; Virk, Hafeez Ul Hassan; Setareh-Shenas, Saman; Patel, Prashant; Kumar, Varun; Shah, Harshil; Patel, Viralkumar; Gidwani, Umesh; Deshmukh, Abhishek; Badheka, Apurva; Gopalan, Radha

doi:10.1016/j.amjcard.2017.05.028

Cited by 39 publications

(34 citation statements)

References 26 publications

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“…Published data for these conditions using the NRD show that readmission rates were 4% and 6.6% within 90 days following knee and hip replacement, respectively, while the 30‐day readmission rates were 14.9% post–acute myocardial infarction, 16.1% post‐pneumonia, 19.2% post–chronic obstructive pulmonary disease, and 20% to 21% post‐CHF hospitalizations (Table 4). 17, 18, 19, 20, 21, 22 This is in comparison to our findings in patients with syncope/collapse who benefited from the CMS program and reported readmission rates of 10.2% to 11.3%.…”

Section: Discussionsupporting

confidence: 57%

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Kadri

Abuamsha

Nusairat

et al. 2018

JAHA

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BackgroundSyncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope.Methods and ResultsWe identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013–2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58–83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6–0.7), female sex (OR, 0.9; 95% CI, 0.8–0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2–1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3–1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2–1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2–1.3), anemia (OR, 1.4; 95% CI, 1.4–1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3–1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5–1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6–1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4–1.6) or >5 days (OR, 2; 95% CI, 1.8–2), and having private insurance (OR, 0.6; 95% CI, 0.6–0.7).ConclusionsThe 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions.

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Section: Discussionsupporting

confidence: 57%

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Kadri

Abuamsha

Nusairat

et al. 2018

JAHA

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“…Hospital admissions are frequent among patients with heart failure (HF)1 with a broad range of clinical presentations and haemodynamic profiles. It has been estimated that half of patients have either arterial hypotension or other signs of tissue hypoperfusion at hospital admission,2 3 and a significant proportion of these patients receive inotropic therapy during the course of hospitalisation 4…”

Section: Introductionmentioning

confidence: 99%

Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy

et al. 2018

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ObjectivesThe prognostic significance of transient use of inotropes has been sufficiently studied in recent heart failure (HF) populations. We hypothesised that risk stratification in these patients could contribute to patient selection for advanced therapies.MethodsWe analysed a prospective cohort of adult patients admitted with decompensated HF and ejection fraction (left ventricular ejection fraction (LVEF)) less than 50%. We explored the outcomes of patients requiring inotropic therapy during hospital admission and after discharge.ResultsThe study included 737 patients, (64.0% male), with a median age of 58 years (IQR 48–66 years). Main aetiologies were dilated cardiomyopathy in 273 (37.0%) patients, ischaemic heart disease in 195 (26.5%) patients and Chagas disease in 163 (22.1%) patients. Median LVEF was 26 % (IQR 22%–35%). Inotropes were used in 518 (70.3%) patients. In 431 (83.2%) patients, a single inotrope was administered. Inotropic therapy was associated with higher risk of in-hospital death/urgent heart transplant (OR=10.628, 95% CI 5.055 to 22.344, p<0.001). At 180-day follow-up, of the 431 patients discharged home, 39 (9.0%) died, 21 (4.9%) underwent transplantation and 183 (42.4%) were readmitted. Inotropes were not associated with outcome (death, transplant and rehospitalisation) after discharge.ConclusionsInotropic drugs are still widely used in patients with advanced decompensated HF and are associated with a worse in-hospital prognosis. In contrast with previous results, intermittent use of inotropes during hospitalisation did not determine a worse prognosis at 180-day follow-up. These data may add to prognostic evaluation in patients with advanced HF in centres where mechanical circulatory support is not broadly available.

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“…The NRD represents 49.3% of total United States hospitalizations. The details regarding the NRD and data extraction methodology are available online (Arora et al, 2017;Chen et al, 2013;Healthcare Cost and Utilization Project, 2014). Patients were tracked during same year using variable ''NRD visit link,'' and the time between 2 admissions was calculated by subtracting variable ''NRD Days to Event''.…”

Section: Methodsmentioning

confidence: 99%

Predictors of 30-day re-admissions in patients with infective endocarditis: a national population based cohort study

Agrawal

Virk

Riaz

et al. 2020

Reviews in Cardiovascular Medicine

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Infective endocarditis (IE) is a life threatening disease requiring lengthy hospitalizations, complex multidisciplinary management and high health care costs. In this study, we analyzed the National Readmissions' Database (NRD) to identify infective endocarditis cases and the causative organisms, clinical determinants, length of stay, in-hospital mortality, and 30-day hospital readmission rates. The study cohort was derived from Healthcare Cost and Utilization Project's National Readmission Database between 2010-15. We queried the National Readmissions' Database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for infective endocarditis (421.0) and identified a total of 187,438 index admissions. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for statistical analyses. A total of 187,438 patients with a primary diagnosis of IE were identified over 6 years (2010-2015). Twenty-four percent (44,151 patients) were readmitted within 30 days. Most common etiologies for readmission included sepsis (14%), acute heart failure (8%), acute kidney injury (6%), intracardiac device infection (5.6%) and recurrence of IE (2.7%). Predictors of increased readmissions included female sex, staphylococcus aureus infection, diabetes, chronic lung disease, chronic liver disease, acute kidney injury, acute heart failure and anemia. Inhospital mortality for the readmission of IE was 13%, and average length of stay during the re-admission was 12 days. IE is associated with high rates of index admission mortality and for 30-day readmissions of which are associated with a substantial risk of death.

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Etiologies, Trends, and Predictors of 30-Day Readmissions in Patients With Diastolic Heart Failure

Cited by 39 publications

References 26 publications

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy

Predictors of 30-day re-admissions in patients with infective endocarditis: a national population based cohort study

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