Death and readmission in the year after hospital admission with cardiovascular disease: the Hunter Area Heart and Stroke Register

Abstract

Objectives To compare outcomes one year after hospital admission for patients initially discharged with a diagnosis of acute myocardial infarction (AMI), other ischaemic heart disease (other IHD), congestive heart failure (CHF) or stroke. Design: Cohort study. Setting Hunter Area Heart and Stroke Register, which registers all patients admitted with heart disease or stroke to any of the 22 hospitals in the Hunter Area Health Service in New South Wales. Patients 4981 patients with AMI, other IHD, CHF or stroke admitted to hospital as an emergency between 1 July 1995 and 30 June 1997 and followed for at least one year. Main outcome measures Death from any cause or emergency hospital readmission for cardiovascular disease. Results: ln‐hospital mortality varied from 1% of those with other IHD to 22% of those with stroke. Almost a third of all patients discharged alive (and 38% of those aged 70 or more) had died or been readmitted within one year. This varied from 22% of those with stroke to 49% of those with CHF. The causes of death and readmission were from a spectrum of cardiovascular disease, regardless of the cause of the original hospital admission. Conclusions Data from this population register show the poor outcome, especially with increasing age, among patients admitted to hospital with cardiovascular disease. This should alert us to determine whether optimal secondary prevention strategies are being adopted among such patients.

A comparison of hospital readmission rates between two general physicians with different outpatient review practices

“…However, similar rates of readmission have been reported from the USA [2] and Australia [3] in similar patient groups. The risk of readmission in these studies was also associated with patient characteristics such as age, co morbidity, depression and previous readmission events [4,5] rather than the quality of patient care [4].…”

Implementing guidelines in primary care: can population impact measures help?

“…We have estimated that 11% of patients with MI develop heart failure based on co-morbidities coded in a population register [10], consistent with prevalence data from UK general practice [11]. …”

“…Similar data for current heart failure treatment come from a UK General Practice survey [11] for ACE-I and an Australian register [10] for spironolactone. The baseline risk of death over the next year among those discharged alive from hospital has been taken from an Australian community register [10].…”

Impact numbers in health policy decisions

“…To calculate the PIN, we have used the prevalence of CHF in the Hunter Valley of Australia, 42 per 10 000 (obtained from a population based register of hospitalised patients) 14 as an estimate for the Australian population.…”

“…Data from the Hunter Area Heart and Stroke Register 14 in Australia show that the risk of death during the next year among patients admitted to hospital with CHF is 29%. Using this figure for baseline risk with estimates of the potential proportion of patients eligible (P e ) and prevalence of the disease CHF (P d ), we obtain the results in table 2.…”