Background: Heart failure (HF) is a prevalent and costly disease state for adult Americans, with 30-day readmissions rates for patients with HF utilized to limit hospital compensation. Objective: To determine the impact of the transitions of care (TOC) service at our institution on 30-day all-cause and HF readmissions and identify predictive risk factors for 30-day all-cause readmission. Methods: Retrospective chart review of patients aged 18 years and older admitted with HF and all subsequent readmissions between October 1, 2015, and September 30, 2017. A weighted logistic regression model was developed to determine risk factors for 30-day all-cause readmission. Results: There were no significant differences in all-cause or HF readmission rates analyzed by TOC service involvement. Significant risk predictors for 30-day all-cause readmission included discharge to a rehabilitation facility (odds ratio [OR] = 9.3) or home with home health (OR = 1.6) versus home with self-care. Comorbidities associated with an increased risk of 30-day all-cause readmission included diabetes, coronary artery disease, and aortic stenosis. Use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and spironolactone was associated with decreased risk of 30-day all-cause readmission. Conclusion: Identified predictors in the patient population with HF at our institution may be used to target patients at increased risk of all-cause readmission within 30 days.

Background Latent tuberculosis infection treatment is a cornerstone of tuberculosis control. Standard treatment is 9 months of daily, self-administered isoniazid (9H). In 2011, the Centers for Disease Control and Prevention recommended 12 doses of isoniazid and rifapentine (3HP), administered once weekly and directly observed, based on a clinical trial demonstrating equal efficacy and higher completion rate than the standard of care (82% vs 69%). The infectious disease clinic at the University of Vermont Medical Center began using the 12-dose regimen in 2012. This study compares the completion rates and safety of the 2 treatments in a real-world setting. Methods Two matched cohorts of 82 patients were compared with matching based on age, sex, refugee, foreign birth, birth in Bhutan, and hospital employee. Results The completion rates did not differ between 3HP and 9H (71% and 75%, respectively; P = 0.51). For 3HP, males had a higher completion rate than did females (80% vs 56%, P = 0.02). For either cohort, the completion rate did not differ by age, foreign birth, refugee, Bhutanese, or hospital employment. Adverse reactions were the most common reasons to discontinue therapy (74%). The rates of permanent drug discontinuation due to an adverse event were 23% (3HP group) and 15% (9H group) (P = 0.17). Conclusions In a cohort of predominantly refugees, completion rates with the 12-dose regimen were not higher than daily, self-administered 9 months of isoniazid. The 12-week regimen was safe and efficient but did not have a higher completion rate.

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