Risk factors for 30-day readmission in patients with congestive heart failure

Mirkin, Katelin A.; Enomoto, Laura M.; Caputo, Gregory M.; Hollenbeak, Christopher S.

doi:10.1016/j.hrtlng.2017.06.005

Cited by 50 publications

(39 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among the 6 million Americans with heart failure (HF), the hospitalization rate is 18 per 1000 patients over the age of 64. This leads to over 700,000 patients that are hospitalized each year [ 2 ]. Although there has been considerable progress in managing patients with HF, the rate of hospitalizations continues to rise each year [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

et al. 2020

View full text Add to dashboard Cite

Introduction Heart failure increases morbidity and mortality in patients admitted for cirrhosis. Our objective was to determine if patients with acute decompensated heart failure (ADHF) and cirrhosis would have increased mortality, hospital length of stay (LOS), and total hospital charges compared to patients with only ADHF. There is also a paucity of data regarding the influence of gender, race, ethnicity, insurance, and cirrhosis-related complications on mortality, hospital length of stay, and total hospitalization charges. In this study, we aim to identify risk factors in a national population cohort from 2016. Methods All patients above 18 years old with cirrhosis and ADHF admitted in 2016 were identified from the Nationwide Inpatient Sample (NIS). Multivariate regression analysis was used to estimate the odds ratio of in-hospital mortality, average length of stay (LOS), and total hospital charges after adjusting for the following factors: age, gender, race, Charlson and Elixhauser scores, primary insurance payer status, hospital type, hospital bed size, hospital region, and hospital teaching status. Statistical analysis was performed by using the survey procedures function in the statistical analysis system (SAS) software. Statistical significance was defined by the two-sided t-test with a p value < 0.05. Results The overall sample contained 363,050 patients. A total of 355,455 patients were admitted with ADHF and 2% of these patients had concomitant cirrhosis ( n = 7595) in 2016. The total mortality rate was 3.4%, hospital LOS was 6.6 days (with a median of 6.5 days), and the mean total hospital charge was $63,120.20. Patients with both ADHF and cirrhosis compared to patients without ADHF had increased mortality, hospital LOS, and cirrhosis-related complications. Conclusions As the incidence and prevalence of ADHF and cirrhosis increases worldwide, we urge the medical community to increase surveillance of patients with both diseases and perform rigorous cardiovascular risk assessments as well to improve patient outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Beta‐blockers decreased the risk of hospitalization in the landmark clinical trials, but as noted previously, the enrollment of blacks in the landmark clinical trials was extremely low. Recent data show that hospitalization rates significantly differ by race,34 and thus inclusion of hospitalization in the end point may confound the results in race‐stratified analyses such as this study.…”

Section: Discussionmentioning

confidence: 92%

“…All‐cause mortality alone (used in this prospective study) may be a better end point than the composite end point of all‐cause mortality+hospitalization (used in our previous, retrospective study) for evaluating beta‐blocker efficacy. Hospitalization of HF patients is influenced by factors that are unrelated to beta‐blocker efficacy more than all‐cause mortality, such as patient refusal, lack of available beds, the number of cardiologists, whether the patient came to the hospital from home or a skilled nursing facility, and even the day of the week 33, 34, 35, 36. Ultimately, hospitalization is the discretion of the treating physician in the emergency room or clinic.…”

Section: Discussionmentioning

confidence: 99%

“…Hospitalization of HF patients is influenced by factors that are unrelated to betablocker efficacy more than all-cause mortality, such as patient refusal, lack of available beds, the number of cardiologists, whether the patient came to the hospital from home or a skilled nursing facility, and even the day of the week. [33][34][35][36] Ultimately, hospitalization is the discretion of the treating physician in the emergency room or clinic. Beta-blockers decreased the risk of hospitalization in the landmark clinical trials, but as noted previously, the enrollment of blacks in the landmark clinical trials was extremely low.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Peterson

She

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundIt remains unclear whether beta‐blockade is similarly effective in black patients with heart failure and reduced ejection fraction as in white patients, but self‐reported race is a complex social construct with both biological and environmental components. The objective of this study was to compare the reduction in mortality associated with beta‐blocker exposure in heart failure and reduced ejection fraction patients by both self‐reported race and by proportion African genetic ancestry.Methods and ResultsInsured patients with heart failure and reduced ejection fraction (n=1122) were included in a prospective registry at Henry Ford Health System. This included 575 self‐reported blacks (129 deaths, 22%) and 547 self‐reported whites (126 deaths, 23%) followed for a median 3.0 years. Beta‐blocker exposure (BBexp) was calculated from pharmacy claims, and the proportion of African genetic ancestry was determined from genome‐wide array data. Time‐dependent Cox proportional hazards regression was used to separately test the association of BBexp with all‐cause mortality by self‐reported race or by proportion of African genetic ancestry. Both sets of models were evaluated unadjusted and then adjusted for baseline risk factors and beta‐blocker propensity score. BBexp effect estimates were protective and of similar magnitude both by self‐reported race and by African genetic ancestry (adjusted hazard ratio=0.56 in blacks and adjusted hazard ratio=0.48 in whites). The tests for interactions with BBexp for both self‐reported race and for African genetic ancestry were not statistically significant in any model (P>0.1 for all).ConclusionsAmong black and white patients with heart failure and reduced ejection fraction, reduction in all‐cause mortality associated with BBexp was similar, regardless of self‐reported race or proportion African genetic ancestry.

show abstract

“…Up to 30% of readmissions occur within 30 days of discharge in patients diagnosed with a cardiovascular condition, predominantly in patients presenting with heart failure [4] and acute myocardial infarction [5]. Defining the risk factors of readmissions is important in determining optimal interventions to reduce readmissions [6][7][8] and improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Association between Sleep Duration and Quality with Readmissions: An Exploratory Pilot-Study among Cardiology Inpatients

et al. 2020

View full text Add to dashboard Cite

Background: Readmissions within 30 days of discharge are prominent among patients with cardiovascular disease. Post hospital syndrome hypothesizes that sleep disturbance during the index admission contributes to an acquired transient vulnerability, leading to increased risk of readmission. This study evaluated the association of in-hospital sleep (a) duration and (b) quality with 30-day all-cause unplanned readmission. Methods: This prospective observational cohort study included patients admitted to the coronary care unit of a South Australian hospital between 2016–2018. Study participants were invited to wear an ActiGraph GT3X+ for the duration of their admission and for two weeks post-discharge. Validated sleep and quality of life questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), were administered. Readmission status and questionnaires were assessed at 30 days post-discharge via patient telephone interview and a review of hospital records. Results: The final cohort consisted of 75 patients (readmitted: n = 15, non-readmitted: n = 60), of which 72% were male with a mean age 66.9 ± 13.1 years. Total sleep time (TST), both in hospital (6.9 ± 1.3 vs. 6.8 ± 2.9 h, p = 0.96) and post-discharge (7.4 ± 1.3 h vs. 8.9 ± 12.6 h, p = 0.76), was similar in all patients. Patient’s perception of sleep, reflected by PSQI scores, was poorer in readmitted patients (9.13 ± 3.6 vs. 6.4 ± 4.1, p = 0.02). Conclusions: Although an association between total sleep time and 30-day readmission was not found, patients who reported poorer sleep quality were more likely to be readmitted within 30 days. This study also highlighted the importance of improving sleep, both in and out of the hospital, to improve the outcomes of cardiology inpatients.

show abstract

Risk factors for 30-day readmission in patients with congestive heart failure

Cited by 50 publications

References 16 publications

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

The Association between Sleep Duration and Quality with Readmissions: An Exploratory Pilot-Study among Cardiology Inpatients

Contact Info

Product

Resources

About