Predictors of early readmission or death in elderly patients with heart failure

Muzzarelli, Stefano; Leibundgut, Gregor; Maeder, Micha T.; Rickli, Hans; Handschin, Rolf; Gutmann, Marc; Jeker, Urs; Buser, Peter; Pfisterer, Matthias; Rocca, Hans‐Peter Brunner‐La

doi:10.1016/j.ahj.2010.05.007

Cited by 110 publications

(95 citation statements)

References 25 publications

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“…Furthermore, patients with multiple chronic conditions are less likely to receive invasive therapies such as implantable cardioverter-defibrillators (ICD) or cardiac resynchronization therapy 57 . There is also growing evidence that increasing burden of comorbidities in patients with heart failure is associated with repeated hospitalization and poor outcomes 58,59 .…”

Section: Discussionmentioning

confidence: 99%

Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis

Rashid

Kwok

Gale

et al. 2016

Eur Heart J Qual Care Clin Outcomes

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Abstract:Aims: We sought to investigate the prognostic impact of co-morbid burden as defined by the Charlson comorbidity index (CCI) in patients with a range of prevalent cardiovascular diseases. Methods & Results:We searched MEDLINE and EMBASE to identify studies that evaluated the impact of CCI on mortality in patients with cardiovascular disease. A random effects meta-analysis was undertaken to evaluate the impact of CCI on mortality in patients with coronary heart disease (CHD), heart failure (HF) and cerebrovascular accident (CVA).A total of 11 studies of acute coronary syndrome (ACS), 2 stable coronary disease, 5 percutaneous coronary intervention (PCI), 13 HF and 4 CVA met the inclusion criteria. An increase in CCI score per point was significantly associated with a greater risk of mortality in patients with ACS (pooled relative risk ratio (RR) 1.33 95%CI 1.15-1.54), PCI (RR 1.21 95% CI1.12-1.31) stable coronary artery disease (RR 1.38 95%CI 1.29-1.48) and HF (RR1.21 95%CI 1.13-1.29), but not CVA. A CCI score >2 significantly increased the risk of mortality in ACS (RR 2.52 95% CI 1.58-4.04), PCI (3.36 95%CI 2.14-5.29), HF (RR 1.76 95%CI 1.65-1.87) and CVA . Conclusion:Increasing co-morbid burden as defined by CCI is associated with a significant increase in risk of mortality in patients with underlying CHD, HF and CVA. CCI provides a simple way of predicting adverse outcomes in patients with CV disease and should be incorporated into decision-making processes when counseling patients.

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Section: Discussionmentioning

confidence: 99%

Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis

Rashid

Kwok

Gale

et al. 2016

Eur Heart J Qual Care Clin Outcomes

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“…Research has shown that mental health issues are common among heart failure patients, (1)(2)(3)(4)(5)(6) and a host of prospective (3,(7)(8)(9)(10) and observational outcome (11)(12)(13)(14) studies have associated mental health issues with increased morbidity, mortality and risk for readmission. Many heart failure outcomes studies measure mental health status using diagnoses and procedure (ICD-9) codes 290-319 (11,15,16).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding

Bender

Smith²

2016

Journal of Cardiac Failure

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Background: Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative ICD-9 coding for, and 'gold standard' clinician documentation of, mental health issues (MHI) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. Methods:A 13% random sample (n=504) was selected from all unique patients (n=3769) hospitalized with a primary HF diagnosis at four San Diego County community hospitals between 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding between 290-319. Records were audited for clinician documentation of MHI.Results: 43% (n=216) had mental health clinician documentation; 33% (n=164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and a Kappa of 0.69 (CI: 0.61-0.79). More specific ICD-9 MHI code bundles had Kappas ranging from 0.44 to 0.82 and sensitivities between 42-82%. Conclusion:Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly 'rule in' MHI for hospitalized heart failure patients. More specific MHI code bundles had fair to almost-perfect agreement, with a wide range of sensitivities for identifying patients with a MHI.

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“…End points vary from composite cardiac measures to both heart failure–specific and all‐cause readmissions within 30 days to durations of ≥6 months, with inconsistent study designs (ie, ambulatory or ADHF). Studies include evaluations of clinical parameters such as angina, low systolic blood pressure, edema levels, elevated jugular venous pressure, age, depressive symptoms, and the presence of coronary heart disease and pacemakers 13. Serum biomarkers have received the most attention, as simple objective measurements that can be and are routinely performed at admission, such as BNP,14, 15, 16 blood urea nitrogen,17, 18 hemoglobin and hematocrit,19 cystatin,15 and cardiac troponin 15.…”

Section: Discussionmentioning

confidence: 99%

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Simon

Schnatz

Romeo

et al. 2018

JAHA

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BackgroundHeart failure is one of the most costly diagnosis‐related groups, largely because of hospital readmissions. Objective assessment of volume status to ensure optimization before hospital discharge could significantly reduce readmissions. We previously demonstrated an ultrasound method of quantifying percentage of cross‐sectional area (CSA) change of the right internal jugular vein with Valsalva that reliably estimates central venous pressure.Methods and ResultsPatients admitted with acute decompensated heart failure (ADHF) underwent ultrasound measurements of the right internal jugular vein at end‐expiration and during the strain phase of Valsalva to determine a percentage of CSA change. An initial subgroup of patients with right heart catheterization and accompanying ultrasound measurements of the right internal jugular vein identified a percentage of CSA change predictive of right atrial pressure (RAP) ≥12 mm Hg. Images of admitted ADHF patients were obtained at admission and discharge for final analysis. Simultaneous right heart catheterization and right internal jugular vein ultrasound measurements demonstrated that a <66% CSA change predicted RAP ≥12 mm Hg (positive predictive value: 87%; P<0.05, receiver operating characteristic curve). Elevated admission RAP by percentage of CSA change normalized by discharge (P<0.05), indicating that this test is significantly responsive to therapeutic interventions. Using the cutoff value of 66% CSA change, normal RAP at discharge had 91% predictive value for patients avoiding 30‐day readmission (P<0.05).ConclusionsThis bedside ultrasound technique strongly correlates to invasive RAP measurement in ADHF patients, identifies restoration of euvolemia, and is predictive of 30‐day ADHF readmission. This tool could help guide inpatient ADHF treatment and may lead to reduced readmissions.

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Predictors of early readmission or death in elderly patients with heart failure

Cited by 110 publications

References 25 publications

Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis

Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

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