Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure

Arora, Shilpkumar; Patel, Prashant; Lahewala, Sopan; Patel, Nilay; Patel, Nileshkumar; Thakore, Kosha; Amin, Ashok R.; Kumar, Varun; Shah, Harshil; Shah, Mahek; Panaich, Sidakpal; Deshmukh, Abhishek; Badheka, Apurva; Gidwani, Umesh; Gopalan, Radha

doi:10.1016/j.amjcard.2016.11.022

Cited by 108 publications

(96 citation statements)

References 27 publications

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“…5,7,8,12 However, in our study, we found that the heightened mortality risk persists up to 18 months, which is a longer duration than previously described and underscores a potentially more persistent post-hospital syndrome. This is consistent with the findings of multiple previous studies of post-hospital syndrome for heart failure and non-heart failure diagnoses.…”

Section: Discussion Significancecontrasting

confidence: 57%

Validity of the Seattle Heart Failure Model after heart failure hospitalization

Marcus

Núñez

et al. 2019

ESC Heart Failure

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Aims Heart failure hospitalization is a sentinel event associated with increased mortality risk. Whether long‐term heart failure risk models such as the Seattle Heart Failure Model (SHFM) accurately assess risk in the post‐hospital setting is unknown. Methods and results The SHFM was applied to a cohort of 2242 consecutive patients (50% women; mean age 73) on discharge after acute heart failure hospitalization and analysed for the primary endpoint of all‐cause mortality. Model discrimination and calibration were assessed. Direct patient‐level comparison between our study cohort and the original SHFM cohorts was also performed to confirm and quantify the degree and extent of increased mortality risk attributable to post‐hospital status. The SHFM demonstrated good overall risk discrimination (area under the receiver operating characteristic curve 0.704) and was well calibrated in patients <65 years old. The SHFM significantly underestimated mortality risk in patients ≥65 years old post‐hospitalization. Direct patient‐level comparison revealed a stepwise increase in adjusted mortality risk attributable to post‐hospital status for each advancing age group ≥65 years old. This heightened mortality risk showed a diminishing trend over 18 months after discharge. Conclusions The SHFM accurately predicts mortality risk in younger patients after acute heart failure hospitalization. However, patients ≥65 years old had increased adjusted mortality risk for up to 18 months after discharge compared with ambulatory heart failure patients, a pattern consistent with the well‐described post‐hospital syndrome.

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Section: Discussion Significancecontrasting

confidence: 57%

Validity of the Seattle Heart Failure Model after heart failure hospitalization

Marcus

Núñez

et al. 2019

ESC Heart Failure

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“…Hospital readmission is a significant source of healthcare expenditure and it has become a quality measure for hospitals nationwide . In 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the Federal Hospital Readmissions Reduction Program (HRRP) to provide reimbursement incentives for hospitals that manage to reduce readmissions and penalties for excessive readmissions among patients hospitalized with certain diagnosis …”

Section: Introductionmentioning

confidence: 99%

Predictors and etiologies of 30‐day readmissions in patients with non‐ST‐elevation acute coronary syndrome

Lemor

Hernandez

Patel

et al. 2018

Cathet Cardio Intervent

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Background Despite improvements in acute care and survival after non‐ST‐elevation acute coronary syndrome (NSTE‐ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact. Objectives Determine the predictors and etiologies of 30‐day readmissions in NSTE‐ACS. Method The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE‐ACS using ICD9 code. Results We identified a total of 300,269 patients admitted with NSTE‐ACS; 13.4% were readmitted within 30‐day. The most common cause of readmission was heart failure (HF) (15.6%), followed by a recurrent myocardial infarction (MI) (10%). Predictors of increased readmissions were age ≥ 75 years (OR: 1.34, 95% CI: 1.30–1.39), female gender (OR 1.12, 95% CI 1.09–1.16), a Charlson Comorbidity Index (CCI) >3 (OR 2.11, 95% CI: 2.04–2.18), ESRD (OR 2.01, 95% CI 1.89–2.14), CKD (OR: 1.58, 95% CI: 1.51–1.64), length of stay ≥5 days (OR: 1.51, 95% CI 1.46–1.56) and adverse events during the index admission such as AKI (OR:1.31, 95% CI: 1.25–1.36), major bleeding (OR:1.20, 95% CI: 1.12–1.24); whereas admission to a teaching hospital (OR 0.92, 95% CI 0.89–0.95) and PCI (OR 0.70, 95% CI 0.67–0.72) were associated with less likelihood of 30‐day readmission. Conclusion Readmission rate at 30‐days is high among NSTE‐ACS patients and the most common readmission etiologies are HF and recurrent MI. A CCI more than 3 and ESRD were the most significant predictors for readmission; patients undergoing PCI had less odds of readmission.

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“…We found that the youngest patients had a 50% increased risk of readmission compared with a much older reference group. Although the relationship between age and readmission is nuanced, relatively younger age has often been associated with increased risk of readmission generally10 and following heart failure specifically 11, 12. The reason for our finding may lie in the discharge destination, as this age effect disappeared when discharges to SNFs alone were considered (and remained when discharges only to home were modeled separately).…”

Section: Discussionmentioning

confidence: 75%

Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study

Wetmore

Molony

Liu

et al. 2018

JAHA

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BackgroundHospitalization for cardiovascular disease (CVD) is common among patients receiving maintenance dialysis, but patterns of readmissions following cardiovascular events are underexplored.Methods and ResultsIn this retrospective analysis of prevalent, Medicare‐eligible patients receiving dialysis in 2012–2013, all live‐discharge hospitalizations attributed to CVD were ascertained. Rates of all‐cause, CVD‐related, and non–CVD‐related readmissions and death in the ensuing 10 and 30 days were calculated. Multinomial logistic modeling was used to assess the relationship between potential explanatory factors and outcomes of interest. Among 142 210 analyzed hospitalizations, mean age at time of index CVD hospitalization was 64.9±14.1 years; 50.4% of index hospitalizations were for women, and 41.4% were for white patients. Fully 15.6% and 34.2% of CVD hospitalizations resulted in readmission within 10 and 30 days, respectively; less than half of readmissions were CVD related (42.5%, 10 days; 43.1%, 30 days). Death within 30 days, regardless of readmission, occurred after 4.5% of index hospitalizations; 51.2% were attributed to CVD. Compared with ages 65 to 69 years, younger age tended to be associated with increased readmission risk (adjusted relative risk for ages 18–44 years: 1.55; 95% confidence interval, 1.48–1.63). Readmission risk did not differ between white and black patients, but risk of death without readmission was markedly lower for black patients (relative risk: 0.60; 95% confidence interval, 0.55–0.67).ConclusionsRoughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days. Risk of death without readmission was higher for white than black patients, despite no difference in risk of readmission.

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Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure

Cited by 108 publications

References 27 publications

Validity of the Seattle Heart Failure Model after heart failure hospitalization

Validity of the Seattle Heart Failure Model after heart failure hospitalization

Predictors and etiologies of 30‐day readmissions in patients with non‐ST‐elevation acute coronary syndrome

Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study

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