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Congestive heart failure (CHF) accounts for more health care costs than any other diagnosis. Readmissions contribute to this expenditure. The authors evaluated the relationship between adherence to performance metrics and 30-day readmissions. This was a retrospective study of 6063 patients with CHF between 2001 and 2008. Data were collected for 30-day readmissions and compliance with CHF performance measures at discharge. Rates of readmission for CHF increased from 16.8% in 2002 to 24.8% in 2008. Adherence to performance measures increased concurrently from 95.8% to 99.9%. Except for left ventricular function (LVF) assessment, the 30-day readmission rate was not associated with adherence to performance measures. Readmitted patients had twice the odds of not having their LVF assessed (odds ratio = 2.0; P < .00005; 95% confidence interval = 1.45-2.63). CHF performance measures, except for the LVF assessment, have little relationship to 30-day readmissions. Further studies are needed to identify performance measures that correlate with quality of care.

Background : Growing numbers of American Veterans are diagnosed with psychological disorders and myocardial infarctions without known preexisting cardiac risk factors. Confronted with this information, we studied the association between psychological disorders and the presence of coronary artery calcium. High risk coronary calcification [Agatston method coronary artery calcium score (CAC) >100] is associated with a striking increase in cardiovascular events (hazard ratio>10) making it an excellent surrogate marker. Methods : From a database of VA patients who have undergone cardiac computed tomography, 483 were studied (age 59±12 years, 86% male). Regression analysis was utilized for comparison of CAC score for individuals with depression, anxiety, post-traumatic stress disorder (PTSD) and substance abuse.. Results : After adjustment for age, gender and cardiac risk factors, the odds ratio of CAC≥100 vs. CAC=0 was 1.24 (95% CI 1.02–2.08, p=0.044) for depression, 2.04 (95% CI 1.11– 6.17, p=0.027) for anxiety, 2.28 (95% CI 1.15–5.76, p=0.026) for PTSD and 2.61 (95% CI 1.14 – 6.03, p=0.022) for substance abuse as compared to normal cohort. Conclusion : Veterans with psychological disorders were found to have a significantly higher coronary artery calcification score than those without such disorders. These findings are independent of age, gender and other traditional cardiac risk factors.

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Introduction Congestive heart failure (CHF) is the most costly disease in the US. Readmission costs contribute significantly to this healthcare expenditure. While adherence to published guidelines has increased, readmission rates have not improved. There is an urgent need to identify clinical and process measures that improve care for CHF patients. Thirty day readmission rates have often been used by third party payers as a surrogate index for quality of care in the inpatients settings. This study looked at the relationship between preadmission patient characteristics and 30 day readmissions. Methods: This was a single center retrospective case-control study that evaluated 6063 consecutive patients admitted with a diagnosis of CHF from December 2001 through December 2008. Data was abstracted for independent and dependent variables, including heart failure performance measures at discharge. This Ad hoc analysis focused on the relationship between patient determinants on 30 day readmissions. Statistical comparison was made between readmitted and non readmitted cohorts. Results: There were 6063 total patients admitted with the principal diagnosis of CHF. A total of 19.6% (1191 of 6063) of the patients were readmitted within 30 days of discharge. Another 19.9% (1211 of 6063) served as control cohort. The mean age for readmitted and non readmitted patients was 77.8(+/- 11.6) and 75.7 (+/- 11.8) years respectively. Mean duration of initial hospital stay for readmitted patients was 5.7 (+/- 4) days and 6.0 (+/-4) days for the control group. Readmitted patients were more likely to be smokers than their counterparts. (O.R= 1.5, 95% CI 1.2-1.9 p=0.002).Non usage of ACEI medication prior to hospitalization was associated with higher rates of readmission (O.R 1.30, 95% CI 1.1-1.6, p=0.003).However beta blocker therapy did not correlate with 30 day readmissions. (O.R 1.0, 95% CI 0.89- 1.19, p=0.970). Conclusions: In patients admitted with CHF, non usage of ACEI prior to hospitalization and smoking history may serve as indicators for early readmissions. Preadmission beta blocker use was not associated with reduced early readmissions. More studies need to be done to stratify determinants that identify patients at risk for early readmissions.