Is Discordance Between Recommended and Actual Postacute Discharge Setting a Risk Factor for Readmission in Patients With Congestive Heart Failure?

Chou, Aileen; Euloth, Tracey; Matcho, Beth; Pastva, Amy M.; Bilderback, Andrew; Freburger, Janet K.

doi:10.1161/jaha.120.020425

Cited by 4 publications

(10 citation statements)

References 40 publications

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“…A recent retrospective cohort study showed that patient non‐adherence to recommended post‐acute care was associated with an increased risk of readmission in patients with chronic HF, and this risk was not significantly increased in the less active population. 25 …”

Section: Discussionmentioning

confidence: 99%

“…Finally, for the patients themselves, any change in their personal compliance, mobility, and post‐discharge retreatment may significantly alter their prognosis. A recent retrospective cohort study showed that patient non‐adherence to recommended post‐acute care was associated with an increased risk of readmission in patients with chronic HF, and this risk was not significantly increased in the less active population 25 …”

Section: Discussionmentioning

confidence: 99%

“…A recent retrospective cohort study showed that patient non-adherence to recommended post-acute care was associated with an increased risk of readmission in patients with chronic HF, and this risk was not significantly increased in the less active population. 25 Due to the diversity and unpredictability of the prognostic factors of HF, the accuracy of most risk scores in predicting patient prognosis gradually decreases with the increase of follow-up time. Most existing studies have verified the long-term prognosis of these risk scores, whereas previous studies have found that patients with HF have a higher risk of adverse outcomes in the early post-discharge period, 6 so predicting short-term adverse events may have more practical value.…”

Section: Discussionmentioning

confidence: 99%

“…Heart failure (HF) is a global public health problem 1 and is one of the leading causes of hospitalization in older people. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 Despite advances in treatment, patients with HF remain at high risk of death. Short‐term readmission of patients with HF often proves to be a serious condition that severely affects the patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…Heart failure (HF) is a global public health problem 1 and is one of the leading causes of hospitalization in older people 2–4 . Despite advances in treatment, patients with HF remain at high risk of death.…”

Section: Introductionmentioning

confidence: 99%

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Performance of the heart failure risk scores in predicting 1 year mortality and short‐term readmission of patients

Zhang

Liu

et al. 2022

ESC Heart Failure

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Aims The aim of this study was to assess the performance of these main scores in predicting prognosis in patients with heart failure (HF). Methods and results A total of 2008 patients who were admitted to the Fourth People's Hospital of Zigong, Sichuan, from December 2016 to June 2019 and diagnosed with HF were included in the study. We compared the prognostic predictive performance of Seattle Heart Failure Model (SHFM), Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC‐HF) risk score, Get With the Guidelines‐Heart Failure programme (GWTG‐HF), Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND) risk scores, the Acute Decompensated Heart Failure National Registry (ADHERE) model, Barcelona Bio‐Heart Failure (BCN‐Bio‐HF) risk calculator, and Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico‐Heart Failure (GISSI‐HF) for the endpoints. The primary endpoint was 1 year all‐cause mortality and the secondary endpoint was the incidence of 28 day readmission post‐discharge. At 1 year follow‐up, 44 (2.21%) patients with HF died. Discrimination analyses showed that all risk scores performed reasonably well in predicting 1 year mortality, with areas under the receiver operating characteristic curve (AUCs) fluctuating between 0.757 and 0.822. GISSI‐HF showed the best discrimination with the AUC of 0.822 (0.768–0.876), followed by MAGGIC‐HF, BCN‐Bio‐HF, ASCEND, SHFM, GWTG‐HF, and ADHERE with AUCs of 0.819 (0.756–0.883), 0.812 (0.758–0.865), 0.802 (0.742–0.862), 0.787 (0.725–0.849), 0.762 (0.684–0.840), and 0.757 (0.681–0.833), respectively. All risk scores were similarly predictive of 28 day emergency readmissions, with AUCs fluctuating between 0.609 and 0.680. Overestimation of mortality occurred in all scores except the ASCEND. The risk scores remained with good prognostic discrimination in patients with biventricular HF and in the subgroup of patients taking angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker. Conclusions Currently assessed risk scores have limited clinical utility, with fair accuracy and calibration in assessing patients' 1 year risk of death and poor accuracy in assessing patients' risk of readmission. There is a need to incorporate more patient‐level information, use more advanced technologies, and develop models for different subgroups of patients to achieve more practical, innovative, and accurate risk assessment tools.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance of the heart failure risk scores in predicting 1 year mortality and short‐term readmission of patients

Zhang

Liu

et al. 2022

ESC Heart Failure

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Quantifying the Risk for Hospital Readmission When Physical Therapist Discharge Recommendations Are Not Followed

Wright

Koch-Hanes

Cortney

et al. 2023

Journal of Acute Care Physical Therapy

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Nearly a fifth of all hospitalized patients are readmitted within 1 month of discharge. 1,2 Unplanned hospital readmissions lead to both poorer patient outcomes and increased health care costs. 1,3 Readmitted patients risk exposure to hospital-acquired infections and medical errors, as well as the potential for delirium, frailty, and mortality. 4,5 The US health care system spends billions of dollars on readmissions. 6,7 These costs, of course, are carried by patients, facilities, third-party payers, and tax payers as a whole. 7-9 Some readmissions appear to be preventable. 7,9,10 Inadequate care during a hospital stay and during the transition period at discharge impacts recovery and the potential for hospital readmission. [11][12][13] Infection, obstruction, respiratory problems, bleeding, and falls are some of the reasons preventable readmissions may occur. [14][15][16] To reduce readmissions, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program. 17 This program penalizes and incentivizes hospitals to decrease unnecessary readmissions during the 30 days following hospital discharge. 18 On average, readmission penalties cost each hospital $200 000 annually, while incentives can reward hospitals between $10 000 and $60 000 for each avoided readmission. 19 Hospitals have responded to these incentives in different ways. 20 Some have trialed postdischarge programs including follow-up telephone calls to patients from hospital staff, patient-activated hotlines, timely communication between hospital providers and ambulatory providers, timely ambulatory provider follow-up, and provider home visits. 21,22 Others have implemented

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Characteristics and Readmission Risks Following Sepsis Discharges to Home

You,

Song,

Hsu

et al. 2024

Medical Care

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Objective: To examine the characteristics and risk factors associated with 30-day readmissions, including the impact of home health care (HHC), among older sepsis survivors transitioning from hospital to home. Research Design: Retrospective cohort study of the Medical Information Mart for Intensive Care (MIMIC)-IV data (2008–2019), using generalized estimating equations (GEE) models adjusting for patient sociodemographic and clinical characteristics. Subjects: Sepsis admission episodes with in-hospital stays, aged over 65, and discharged home with or without HHC were included. Measures: The outcome was all-cause hospital readmission within 30 days following sepsis hospitalization. Covariates, including the primary predictor (HHC vs. Home discharges), were collected during hospital stays. Results: Among 9115 sepsis admissions involving 6822 patients discharged home (66.8% HHC, 33.2% Home), HHC patients, compared with those discharged without services, were older, had more comorbidities, longer hospital stays, more prior hospitalizations, more intensive care unit admissions, and higher rates of septic shock diagnoses. Despite higher illness severity in the HHC discharges, both groups had high 30-day readmission rates (30.2% HHC, 25.2% Home). GEE analyses revealed 14% higher odds of 30-day readmission for HHC discharges after adjusting for risk factors (aOR: 1.14; 95% CI: 1.02–1.27; P=0.02). Conclusions: HHC discharges experienced higher 30-day readmission rates than those without, indicating the need for specialized care in HHC settings for sepsis survivors due to their complex health care needs. Attention to sepsis survivors, regardless of HHC receipt, is crucial given the high readmission rates in both groups. Further research is needed to optimize postacute care/interventions for older sepsis survivors.

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Is Discordance Between Recommended and Actual Postacute Discharge Setting a Risk Factor for Readmission in Patients With Congestive Heart Failure?

Cited by 4 publications

References 40 publications

Performance of the heart failure risk scores in predicting 1 year mortality and short‐term readmission of patients

Performance of the heart failure risk scores in predicting 1 year mortality and short‐term readmission of patients

Quantifying the Risk for Hospital Readmission When Physical Therapist Discharge Recommendations Are Not Followed

Characteristics and Readmission Risks Following Sepsis Discharges to Home

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