Assessment of Discharge Readiness and Readmission Risk in Patients With Acute Decompensated Heart Failure

Oehler, Andrew; Kent, K. Craig; Davis, Jonathan

doi:10.1016/j.amjcard.2018.08.061

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…Many patients discharged for decompensated HF remain volume overloaded at the time of discharge [ 23 , 24 ]; and guideline suggestions for transition to oral diuretics may need to be balanced with approaches to maximize inpatient time by focusing on attaining euvolemia with the more effective IV diuretics. While achievement of euvolemia with IV diuretics and transition to a trial of oral diuretics prior to discharge are not mutually exclusive, the financial and other burdens associated with the required increase in LOS to achieve the desired 24 h or greater observation period may deserve significant scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Trial of Oral Diuretics Prior to Discharge Is Not Associated With Improved Outcomes in Decompensated Heart Failure

et al. 2021

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Background: Current heart failure guidelines recommend transition of intravenous (IV) diuretics to oral > 24 h prior to hospital discharge. The aim of this study was to determine whether transition to oral diuretics prior to discharge in patients hospitalized with decompensated systolic heart failure (SHF) was associated with improved 30-day events.Methods: This was a retrospective cohort study, in which adults admitted to the Loma Linda Medical Center for 3 -14 days with a primary discharge diagnosis of acute on chronic SHF were included. Mortality data were obtained from the National Death Index, while readmission only to our facility was included. The t-test and Chisquare test were used for analyses.Results: A total of 314 patients were studied. Patients who were managed with guideline-recommended trial of oral diuretics, and patients who continued to receive IV diuretics on the last full hospital day were overall similar in baseline characteristics. Patients who received oral diuretics on the day prior to discharge had longer length of stay, less weight loss, were discharged on lower diuretic doses (all P < 0.05), and had similar outcomes of 30-day readmission and 30-day hospitalization-free survival. Conclusions:The transition to oral diuretics prior to discharge in patients with decompensated SHF was not associated with improved 30-day outcomes. These results require validation in prospective trials but suggest that guideline recommendations regarding transitioning to oral diuretics prior to discharge may deserve re-evaluation.

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Section: Discussionmentioning

confidence: 99%

Trial of Oral Diuretics Prior to Discharge Is Not Associated With Improved Outcomes in Decompensated Heart Failure

et al. 2021

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Discharge readiness as an infrastructure: Negotiating the transfer of care for elderly patients in medical wards

Skovgaard

Jørgensen

Tjørnhøj‐Thomsen

et al. 2022

Social Science & Medicine

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Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery

Mary,

Mzayek,

Lefler

et al. 2024

Professional Case Management

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Purpose of Study: Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery. Primary Practice Setting(s): The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital. Methodology and Sample: A retrospective case–control study was employed to examine 1,712 patients who underwent CABG surgery. Results: The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001). Implications for Case Management Practice: Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.

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Assessment of Discharge Readiness and Readmission Risk in Patients With Acute Decompensated Heart Failure

Cited by 3 publications

References 24 publications

Trial of Oral Diuretics Prior to Discharge Is Not Associated With Improved Outcomes in Decompensated Heart Failure

Trial of Oral Diuretics Prior to Discharge Is Not Associated With Improved Outcomes in Decompensated Heart Failure

Discharge readiness as an infrastructure: Negotiating the transfer of care for elderly patients in medical wards

Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery

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