Disparities in the characteristics and outcomes of patients hospitalized with acute decompensated heart failure admitted to internal medicine and cardiology departments: a single‐centre, retrospective cohort study

Abstract

Aims Efforts are constantly made to decrease the rates of readmission after acute decompensated heart failure (ADHF). ADHF admissions to internal medicine departments (IMD) were previously associated with higher risk for readmission compared with those admitted to cardiology departments (CD). It is unknown if the earlier still applies after recent advancement in care over the last decade. This contemporary cohort compares characteristics and outcomes of ADHF patients admitted to IMD with those admitted to CD. Methods and results The data for this single‐centre, retrospective study utilized a cohort of 8332 ADHF patients admitted between 2007 and 2017. We compared patients' baseline characteristics and clinical and laboratory indices of patients admitted to CD and IMD with the outcome defined as 30 day readmission rate. In comparison with those admitted to CD, patients admitted to IMD (89.5% of patients) were older (79 [70–86] vs. 69 [60–78] years; P < 0.001) and had a higher incidence of co‐morbidities and a higher ejection fraction. Readmission rates at 30 days were significantly lower in patients admitted to CD (15.9% vs. 19.6%; P = 0.01). Conflicting results of three statistical models failed to associate between the admitting department and 30 day readmission (odds ratio for 30 day readmission in CD: forced and backward stepwise logistic regression 0.8, 95% confidence interval 0.65–0.97, P = 0.02; stabilized inverse probability weights model odds ratio 1.0, confidence interval 0.75–1.37, P = 0.96). Conclusions This contemporary analysis of ADHF patient cohort demonstrates significant differences in the characteristics and outcomes of patients admitted to IMD and CD. Thus, focusing strategies for readmission prevention in patients admitted to IMD may be beneficial.

Phenotyping congestion in patients with acutely decompensated heart failure with preserved and reduced ejection fraction: The Decongestion duRing therapY for acute decOmpensated heart failure in HFpEF vs HFrEF- DRY-OFF study

“…In agreement with the findings by Mayman et al on HF patients admitted to Internal Medicine units, the mean age of the patients is much higher than those included in clinical trials and even in community-based studies on ADHF [18]. HFpEF patients represent over 50% of the entire cohort, indicating, as previously reported, that the two HF phenotypes are at least equally prevalent among hospitalized patients [19,20].…”

Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure

“…Indeed, in the current study, the number of patients ≥85 years and their mean age is higher than that analyzed in previous reports, either in Italy or Europe [5,13,16]. Furthermore, at odds with previous studies based on registries and surveys [5,19], we considered exclusively patients admitted to internal medicine wards as it has been documented that those admitted to cardiology units are a selected group of younger patients with significant differences in clinical characteristics and outcomes, in Italy and elsewhere [20,21].…”

Relationship between comorbidity and health outcomes in patients with heart failure: A systematic review and meta-analysis

“…We were able to perform the meta-analysis for three domains of the SCHFI: con dence, maintenance and management. A total of 34 primary studies were pooled to calculate the overall effect size of comorbid conditions on prognostic outcomes: in-hospital mortality (21,23,26,29,32,33,40,57), all-cause mortality (18, 19, 24-27, 36, 37, 43, 47, 48, 50, 51, 55, 57-59), all-cause readmission (27,28,30,32,34,37,38,41,44,45,55,58), HF-related readmission (20,28,35,37,51,53,57), non-HF-related readmission (28, 53) and delayed length of hospital stay (23,32). Among the prognostic outcome measures, all-cause mortality was the only measure with su cient data for the meta-analysis based on the follow-up periods.…”

“…The pooled analysis of 18 studies (18, 19, 24-27, 31, 36, 37, 43, 47, 48, 50, 51, 55, 57-59) indicated that HF patients with comorbidity had a statistically higher risk of all-cause mortality (HR 1.31, 95% CI 1.18, 1.45, p < 0.001). In addition, the presence of comorbidity signi cantly increased the risk of all-cause readmission (HR 1.16, 95% CI 1.09, 1.23, p < 0.001) (27,28,30,32,34,37,38,41,44,45,55,58), HF-related readmission (HR 1.13, 95% CI 1.05, 1.23, p = 0.001) (20,28,35,37,51,53,57) and non-HF-related readmission (HR 1.17, 95% CI 1.07, 1.27, p < 0.001) (28, 53). However, no signi cance was noted for in-hospital mortality and longer length of hospital stay (Fig.…”