Do Countries or Hospitals With Longer Stays Have Lower Readmission Rates? Findings From the Ascend-Hf Trial

Eapen, Zubin J.; Reed, Shelby D.; Li, Yanhong; Armstrong, Paul W.; Starling, Randall; McMurray, John J.V.; Massie, Barry M.; Swedberg, Karl; Fonarow, Gregg; Teerlink, John R.; Metra, Marco; Whellan, David J.; O’Connor, Christopher M.; Califf, Robert M.; Hernandez, Adrian F.

doi:10.1016/s0735-1097(12)61030-4

Cited by 35 publications

(53 citation statements)

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“…While population-level trends demonstrate an increased risk of readmission contemporaneous with reduced length of stay 25 and countries with longer length of stay tend to have reduced readmission rates, 26 we found greater length of stay was associated with an increased hazard for readmission. In this case, greater length of stay may represent greater HF disease severity, greater complexity of the AHF episode, greater overall burden of comorbidity, socioeconomic barriers to safe hospital discharge, or simply reflect practice patterns that differ by geographic location.…”

Section: Discussioncontrasting

confidence: 62%

Timing and Causes of Readmission After Acute Heart Failure Hospitalization—Insights From the Heart Failure Network Trials

Vader

LaRue

Stevens

et al. 2016

Journal of Cardiac Failure

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Background Readmission or death following heart failure (HF) hospitalization is a consequential and closely scrutinized outcome, but risk factors may vary by population. We characterized the risk factors for post-discharge readmission/death in subjects treated for acute heart failure (AHF). Methods and Results A post hoc analysis was performed on data from 744 subjects enrolled in three AHF trials conducted within the Heart Failure Network (HFN): Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE-AHF), CARdiorenal REScue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF). All-cause readmission/death occurred in 26% and in 38% of subjects within 30- and 60-days of discharge, respectively. Non-HF cardiovascular causes of readmission were more common in the ≤ 30 day timeframe vs. the 31-60 day timeframe (23% vs. 10%, p=0.016). In a Cox proportional hazards model adjusting a priori for LVEF < 50% and trial, the risk factors for all-cause readmission/death included: elevated baseline BUN, ACEI/ARB non-use, lower baseline sodium, non-white race, elevated baseline bicarbonate, lower SBP at discharge/day 7, depression, increased length of stay, and male sex. Conclusions In an AHF population with prominent congestion and prevalent renal dysfunction, early readmissions were more likely to be due to non-HF cardiovascular causes compared to later readmissions. The association between use of ACEI/ARB and lower all-cause readmission/death in Cox proportional hazards model suggests a role for these drugs to improve post-discharge outcomes in AHF.

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Section: Discussioncontrasting

confidence: 62%

Timing and Causes of Readmission After Acute Heart Failure Hospitalization—Insights From the Heart Failure Network Trials

Vader

LaRue

Stevens

et al. 2016

Journal of Cardiac Failure

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“…While the absolute rates were higher for both outcomes in our cohort within each HFRS stratum than in the UK data,5 differences in hospital use patterns and postdischarge outcomes are common between countries,13 and the important finding was the similar gradient of risk across HFRS strata. Thus, we have validated the generalisability of the HFRS (for the outcomes of prolonged hospital LOS or 30-day mortality) in a different healthcare system, geographical region and time period from where it was derived and initially validated.…”

Section: Discussioncontrasting

confidence: 52%

External validation of the Hospital Frailty Risk Score and comparison with the Hospital-patient One-year Mortality Risk Score to predict outcomes in elderly hospitalised patients: a retrospective cohort study

McAlister

Walraven

2018

BMJ Qual Saf

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ObjectiveFrailty is an important prognostic factor in hospitalised patients but typically requires face-to-face assessment by trained observers to detect. Thus, frail patients are not readily apparent from a systems perspective for those interested in implementing quality improvement measures to optimise their outcomes. This study was designed to externally validate and compare two recently described tools using administrative data as potential markers for frailty: the Hospital Frailty Risk Score (HFRS) and the Hospital-patient One-year Mortality Risk (HOMR) Score.DesignRetrospective cohort study.SettingOntario, Canada.ParticipantsAll patients over 75 with at least one urgent non-psychiatric hospitalisation between 2004 and 2010.Main outcome measuresProlonged hospital length of stay (>10 days), 30-day mortality after admission and 30-day postdischarge rates of urgent readmission or emergency department (ED) visits.ResultsIn 452 785 patients (25.9% with intermediate or high-risk HFRS), increased HFRS was associated with higher Charlson scores, older age and decreased likelihood of baseline independence. Patients with high or intermediate HFRS had significantly increased risks of prolonged hospitalisation (70.0% (OR 8.64, 95% CI 8.30 to 8.99) or 49.7% (OR 3.66, 95% CI 3.60 to 3.71) vs 21.3% in low-risk HFRS group) and 30-day mortality (15.5% (OR 1.27, 95% CI 1.20 to 1.33) or 16.8% (OR 1.39, 95% CI 1.36 to 1.41) vs 12.7% in low-risk), but decreased risks of 30-day readmission (10.0% (OR 0.74, 95% CI 0.69 to 0.79) and 11.2% (OR 0.84, 95% CI 0.82 to 0.86) vs 13.1%) or ED visit (7.3% (OR 0.41, 95% CI 0.38 to 0.45) and 11.1% (OR 0.66, 95% CI 0.38 to 0.45) vs 16.0%). Although only loosely associated (Pearson correlation coefficient 0.265, p<0.0001), both the HFRS and HOMR Score were independently associated with each outcome—HFRS was more strongly associated with prolonged length of stay (C-statistic 0.71) and HOMR Score was more strongly associated with 30-day mortality (C-statistic 0.71). Both poorly predicted 30-day readmissions (C-statistics 0.52 for HFRS and 0.54 for HOMR Score).ConclusionsThe HFRS best identified hospitalised older patients at higher risk of prolonged length of stay and the HOMR score better predicted 30-day mortality. However, neither score was suitable for predicting risk of readmission or ED visit in the 30 days after discharge. Thus, a single score is inadequate to prognosticate for all outcomes associated with frailty.

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“…The ASTRONAUT trial population was notable for inclusion of >25% of patients from Asian/Pacific countries. To our knowledge, we present the first data on post‐discharge outcomes beyond 30 days for HHF patients from India, Phillipines, Singapore, Turkey, and Taiwan . Compared with North Americans, ASTRONAUT patients from these countries carried substantially greater risk of post‐discharge death at 6‐ and 12‐month follow‐up.…”

Section: Discussionmentioning

confidence: 92%

“…In this respect, there is growing recognition of geographic variation in HF patient profiles and the interplay with increasing globalization of clinical trials . Despite comprehensive inclusion and exclusion criteria, wide variation in patient characteristics by geographic region has been well documented in previous studies . Likewise, region of origin has been shown to be an independent predictor of clinical outcomes following adjustment for patient risk factors and therapy .…”

Section: Introductionmentioning

confidence: 99%

Global variation in clinical profile, management, and post‐discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial

Greene

Fonarow

Solomon

et al. 2015

European J of Heart Fail

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Aims This study sought to investigate regional variation in clinical characteristics, therapy utilization, and post‐discharge outcomes among patients hospitalized for heart failure (HHF) enrolled in the multinational ASTRONAUT (Aliskiren Trial on Acute Heart Failure Outcomes) trial. Methods and results The ASTRONAUT trial randomized 1615 HHF patients with ejection fraction ≤40% to aliskiren or placebo. Enrolled patients were from Eastern Europe (n = 495, 30.7%), Asia/Pacific (n = 439, 27.2%), Western Europe (n = 395, 24.5%), Latin America (n = 163, 10.1%), and North America (n = 123, 7.6%). Marked differences were seen across geographic regions in terms of baseline demographics, vital signs, laboratory tests, co‐morbidity burden, and use of guideline‐recommended therapies. All‐cause death at 12 months ranged from 7.3% in North America to 26.7% in Asia/Pacific, with differences largely driven by sudden cardiac death. Rates of repeat HHF at 12 months ranged from 22.7% in Latin America to 43.9% in North America. After adjustment for patient characteristics, region was an independent predictor of death at 12 months, with highest risk in Asia/Pacific (hazard ratio 3.04, 95% confidence interval 1.47–6.29, compared with North America) and lowest risk in North America and Western Europe. There was no association between region and the composite of cardiovascular mortality or HHF. Conclusion For patients enrolled in this HHF trial, baseline characteristics and risk of death differed markedly by geographic region. Rates of death and repeat HHF demonstrated a general inverse relationship. Global differences in patient characteristics and outcomes should be accounted for when designing future HHF clinical trials.

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Do Countries or Hospitals With Longer Stays Have Lower Readmission Rates? Findings From the Ascend-Hf Trial

Cited by 35 publications

References 0 publications

Timing and Causes of Readmission After Acute Heart Failure Hospitalization—Insights From the Heart Failure Network Trials

Timing and Causes of Readmission After Acute Heart Failure Hospitalization—Insights From the Heart Failure Network Trials

External validation of the Hospital Frailty Risk Score and comparison with the Hospital-patient One-year Mortality Risk Score to predict outcomes in elderly hospitalised patients: a retrospective cohort study

Global variation in clinical profile, management, and post‐discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial

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