Impact of angiotensin-converting enzyme inhibitor underdosing on rehospitalization rates in congestive heart failure

Luzier, Aileen Bown; Forrest, Alan; Adelman, Martin H.; Hawari, Feras; Schentag, Jerome J.; Izzo, Joseph L.

doi:10.1016/s0002-9149(98)00361-0

Cited by 64 publications

(40 citation statements)

References 13 publications

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“…Our search strategy included any patient admitted with a primary discharge diagnosis for heart failure (ICD 9-CM code 428 or diagnosis-related group code 127). 28,29 ADHF at presentation was confirmed through chart review using the Framingham criteria (sensitivity, 100%; specificity, 78%; see Table 1). 30 Only the patients who met the Framingham criteria were included in the study population.…”

Section: Patient Populationmentioning

confidence: 99%

Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure

Schuberth

Elasy²,

Butler³

et al. 2008

Circulation

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Background-In response to residency work hour restrictions, programs restructured call schedules, increasing the use of short call (daytime admitting teams). Few data exist on the effect of short call on quality of patient care. Our objective was to examine the effect of short call admission on length of stay and quality of care for patients with acute decompensated heart failure. Methods and Results-We conducted a retrospective cohort study of 218 patients admitted with acute decompensated heart failure to the Nashville VA Medical Center between July 1, 2003, and June 30, 2005. The primary exposure was short call, and the primary outcome was length of stay. The secondary outcomes-diuretic dosing, weight monitoring, and hospital complications-were determined through a combination of administrative data and chart review. Patients admitted to short call had a longer median length of stay than patients admitted to long call (5.2 days [25% to 75%, 3.2 to 8 days] versus 3.9 days [interquartile range, 2.7 to 6.5 days]; Pϭ0.0004). After adjustment for covariates, short call had a 44% increase in length of stay (95% CI, 15 to 80) compared with long call. Short call patients received fewer diuretic doses in the first 24 hours of hospitalization (1.80 versus 2.12; Pϭ0.014) and had a longer median time to the second dose of loop diuretics compared with long call patients (17.9 hours versus 16.2 hours; Pϭ0.044). Conclusions-Admission to short call is predictive of increased length of stay, a decreased number of diuretic doses, and delays in the timing of diuretics among patients with acute decompensated heart failure. Additional studies are needed to clarify the impact of short call admission on inpatient quality of care.

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Section: Patient Populationmentioning

confidence: 99%

Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure

Schuberth

Elasy²,

Butler³

et al. 2008

Circulation

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“…ACE inhibitor dosages were converted to enalapril-equivalent dosages according to the target daily doses recommended for heart failure in the Dutch reference desk book. This method has been used previously [19] and uses enalapril 20 mg as reference dose with equivalent doses of captopril 150 mg, ramipril 10 mg, quinapril 20 mg, lisinopril 20 mg, fosinopril 40 mg and perindopril 4 mg.…”

Section: Outcome Variablesmentioning

confidence: 99%

Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study

Kasje

Denig

Stewart

et al. 2005

Eur J Clin Pharmacol

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“…Rehospitalization is increasingly being used not only as a clinical outcome, but also as an end point in clinical trials of 15 have been shown to decrease hospitalization rates in patients with congestive heart failure, and ␤-blockers have been shown to decrease the need for rehospitalization in survivors of an acute coronary syndrome. 16 In the field of stroke, antiplatelet therapy before hospital discharge is a widely accepted recommendation for secondary stroke prevention as well as an indicator of quality of stroke care.…”

Section: Rehospitalization: a New End Point In Clinical Trials?mentioning

confidence: 99%

Poststroke Care

Saposnik

Kapral

2007

Stroke

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M ajor advances in acute stroke management have been seen over the past decade, including the use of thrombolysis, antithrombotic therapy, and organized in-hospital stroke care. However, relatively few studies have evaluated the effectiveness of these interventions in routine clinical practice, or have assessed issues related to delivery of services, access to care, and long-term care after discharge from stroke.In this issue of Stroke, Bravata et al 1 contribute to our understanding of outcomes after stroke by analyzing readmissions and deaths in the first 5 years after a hospitalization for stroke. The target population included stroke survivors aged over 65 years who were Medicare beneficiaries and who were discharged from Connecticut acute care hospitals in 1995. This population was followed from discharge in 1995 through 2000 using Medicare claims and Social Security Administration mortality data. Among 2603 patients discharged alive, 40% were readmitted at least once within the first year of discharge, 53% had died or been readmitted within 1 year and only 15% survived admission-free for 5 years. Leading causes for readmission included pneumonia (8.2% to 9.0%), stroke (3.9% to 6.1%) and acute myocardial infarction (4.2% to 6.0%). There was no apparent association between length of hospital stay and readmission rate (unreported data kindly provided by the authors, 2007), and no information was available on potential patient and system factors associated with higher hospital readmission rates.Lower readmission rates of 25% to 27% within 1 year have been previously reported. 2,3 These studies found that the average number of days of rehospitalization was 23. 2 Stroke was the single most frequent reason for readmission followed by cardiac disease, with no significant differences among ethnic groups (blacks, Hispanics, and whites). 3 However, the strikingly high death and readmission rates after stroke published by Bravata et al are consistent with findings from some previous reports. For example, in a study including veterans living in the state of Florida, 12-month rehospitalization rate was 31.1%, whereas mortality rate was 11.7%. Dual or triple system use (Veterans Health Administration, Medicare, or Medicaid), malnutrition, dysphagia and stroke type were associated with hospital readmissions. 4 In another study including Medicare beneficiaries from 11 metropolitan regions in the eastern of US, mortality (18% to 23%) and rehospitalization (37% to 47%%) rates 11 months after stroke were similar for 30-day survivors. 5 What Does This Study Add toOur Knowledge?The study of Bravata et al revealed a mixed picture with regard to the often neglected battle against stroke: long-term poststroke care. This descriptive study confirms the enormous impact of stroke on hospitalization-free survival. However, the reasons behind the high observed death and readmission rates remain incompletely understood, and the reader may wonder whether these rates were expected or unexpected.Were these findings the natural consequence o...

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Impact of angiotensin-converting enzyme inhibitor underdosing on rehospitalization rates in congestive heart failure

Cited by 64 publications

References 13 publications

Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure

Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure

Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study

Poststroke Care

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