One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factors

Abstract

ObjectivesIdentification of rehospitalisations for heart failure and contributing factors flags health policy intervention opportunities designed to deliver care at a most effective and efficient level. Recognising that heart failure is a condition for which timely and appropriate outpatient care can potentially prevent the use of inpatient services, we aimed to determine to what extent comorbidities and material deprivation were predictive of 1 year heart failure specific rehospitalisation.SettingAll Portuguese mainland National Health Service (NHS) hospitals.ParticipantsA total of 68 565 hospitalisations for heart failure principal cause of admission, from 2011 to 2015, associated to 45 882 distinct patients aged 18 years old or over.Outcome measuresWe defined 1 year specific heart failure rehospitalisation and time to rehospitalisation as outcome measures.ResultsHeart failure principal diagnosis admissions accounted for 1.6% of total hospital NHS budget, and over 40% of this burden is associated to patients rehospitalised at least once in the 365-day follow-up period. 22.1% of the patients hospitalised for a principal diagnosis of heart failure were rehospitalised for the same cause at least once within 365 days after previous discharge. Nearly 55% of rehospitalised patients were readmitted within 3 months. Results suggest a mediation effect between material deprivation and the chance of 1 year rehospitalisation through the effect that material deprivation has on the prevalence of comorbidities. Heart failure combined with chronic kidney disease or chronic obstructive pulmonary disease increases by 2.8 and 2.2 times, respectively, the chance of the patient becoming a frequent user of inpatient services for heart failure principal cause of admission.ConclusionsOne-fifth of patients admitted for heart failure are rehospitalised due to heart failure exacerbation. While the role of material deprivation remained unclear, comorbidities considered increased the chance of 1 year heart failure specific rehospitalisation, in particular, chronic kidney disease and chronic obstructive pulmonary disease.

Impact analysis of heart failure across European countries: an ESC‐HFA position paper

“… 1 The reasons for readmissions are often related to incomplete decongestion, warranting better implementation of HF care pathways, as well as to other conditions (e.g. DM, chronic obstructive pulmonary disease, and chronic kidney disease), 45 mirroring the high burden of comorbidities in HF. 44 …”

The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology

“… 3 Furthermore, one-fifth of patients admitted for heart failure (HF) are rehospitalised within one year due to a HF exacerbation. 4 The improved survival following a cardiac event results in a growing number of patients living with a heart disease. 5 Therefore, there is need for optimal lifelong secondary prevention.…”

“…Although the core components and the effectiveness of secondary prevention and CR are well established, rehospitalisation rates for HF and recurrent events for CAD patients remain disappointingly high. 3,4 Important causes are the low uptake of CR and poorer long-term adoption of secondary prevention measures, as shown recently in the EuroAspire audits. 1,11 An array of factors contributes to these low participation rates.…”

Two-­year prognosis of patients hospitalized for decompensated heart failure in a district general hospital

“…1,10,30 Several relevant risk factors for poorer HF prognosis have been reported and those were confirmed in our study. 13,[31][32][33][34][35][36][37][38][39] The MADIT II (Multicenter Automatic Defibrillator Implan tation Trial II) cohort analysis identified re nal failure as one of the strongest predictors of poor prognosis. 35 Gheorghiade et al 36 and Ambrosy et al 37 listed renal failure and low systolic blood pressure among factors influ encing the prognosis of patients hospitalized for HF.…”