Trends in and predictors of multiple readmissions following heart failure hospitalization: A National wide analysis from the United States

Thandra, Abhishek; Balakrishna, Akshay Machanahalli; Walters, Ryan W.; Alugubelli, Navya; Koripalli, Venkata Sandeep; Alla, Venkata

doi:10.1016/j.amjms.2022.09.006

Cited by 3 publications

(4 citation statements)

References 33 publications

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“…Different studies have demonstrated that a better coordination between different healthcare levels reduces not only hospitalization, but also mortality among patients with HF [ 39 , 40 ]. Despite that, the risk of readmissions following a HF hospitalization or visit to the emergency department due to HF decompensation is still high [ 12 , 41 ]. Delaying medical care is associated with a higher HF burden, including medical costs [ 38 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain

Escobar,

Palacios,

Gonzalez

et al. 2023

BMC Health Serv Res

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Objective To describe healthcare resource utilization (HCRU) and costs, in patients with newly diagnosed heart failure (HF) according to ejection fraction (EF) in Spain. Methods Retrospective cohort study that analyzed anonymized, integrated and computerised medical records in Spain. Patients with ≥ 1 new HF diagnosis between January 2013 and September 2019 were included and followed-up during a 4-year period. Rates per 100 person-years of HCRU and costs were estimated. Results Nineteen thousand nine hundred sixty-one patients were included, of whom 43.5%, 26.3%, 5.1% and 25.1% had HF with reduced, preserved, mildly reduced and unknown EF, respectively. From year 1 to 4, HF rates of outpatient visits decreased from 1149.5 (95% CI 1140.8–1159.3) to 765.5 (95% CI 745.9–784.5) and hospitalizations from 61.7 (95% CI 60.9–62.7) to 15.7(14.7–16.7) per 100 person-years. The majority of HF-related healthcare resource costs per patient were due to hospitalizations (year 1–4: 63.3–38.2%), followed by indirect costs (year 1–4: 12.2–29.0%), pharmacy (year 1–4: 11.9–19.9%), and outpatient care (year 1–4: 12.6–12.9%). Mean (SD) per patient HF-related costs decreased from 2509.6 (3518.5) to 1234.6 (1534.1) Euros (50% cost reduction). At baseline, 70.1% were taking beta-blockers, 56.3% renin-angiotensin system inhibitors, 11.8% mineralocorticoid receptor antagonists and 8.9% SGLT2 inhibitors. At 12 months, these numbers were 72.3%, 65.4%, 18.9% and 9.8%, respectively. Conclusions Although the economic burden of HF decreased over time since diagnosis, it is still substantial. This reduction could be partially related to a survival bias (sick patients died early), but also to a better HF management. Despite that, there is still much room for improvement.

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Section: Discussionmentioning

confidence: 99%

Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain

Escobar,

Palacios,

Gonzalez

et al. 2023

BMC Health Serv Res

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“…5 Notably, these rates do not appear to be declining over time. 6 These readmissions, many of which may be preventable, are stressful adverse events for patients and exert an enormous financial and resource burden on health care systems. 7 In a clinically observed pattern termed posthospital syndrome, patients face a period of heightened risk of functional decline after being discharged to home following hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…Among Medicare beneficiaries, HF is the most common cause of hospitalization and subsequent readmission, 3 with almost a quarter of Medicare patients hospitalized for HF readmitted within 30 days of discharge 4 and readmission rates as high as 67% within a year 5 . Notably, these rates do not appear to be declining over time 6 . These readmissions, many of which may be preventable, are stressful adverse events for patients and exert an enormous financial and resource burden on health care systems 7…”

Section: Introductionmentioning

confidence: 99%

Vulnerability to functional decline is associated with noncardiovascular cause of 90‐day readmission in hospitalized patients with heart failure

Trochez,

Barrett,

Shi

et al. 2024

Journal of Hospital Medicine

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BackgroundHospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions.ObjectivesWe examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure.Designs, Settings, and ParticipantsThis prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study.Main Outcome and MeasuresThe primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES‐13).ResultsAmong 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR] = 1.36, 95% confidence interval [CI]: 1.06–1.75) in the first 90 days after discharge. The VES‐13 score was not associated with readmission for cardiovascular causes (RRR = 0.94, 95% CI: 0.75–1.17).ConclusionsVulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES‐13 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.

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“…Heart failure is the leading cause of cardiovascular-related death worldwide, and coronary artery disease (CAD) is the principal cause of heart failure. 1 , 2 The prospect of reviving viable but ischemic or hibernating myocardium through revascularization has fueled substantial research. 1 , 3 Current multisociety guidelines favor revascularization with coronary artery bypass grafting (CABG) over optimal medical therapy (OMT) alone to improve all-cause mortality in patients with severe ischemic left ventricular systolic dysfunction (LVSD) with ejection fraction of less than or equal to 35%.…”

mentioning

confidence: 99%

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Severe Ischemic Left Ventricular Systolic Dysfunction

Mathew Kalathil,

Machanahalli Balakrishna,

El-Shaer

et al. 2024

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Trends in and predictors of multiple readmissions following heart failure hospitalization: A National wide analysis from the United States

Cited by 3 publications

References 33 publications

Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain

Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain

Vulnerability to functional decline is associated with noncardiovascular cause of 90‐day readmission in hospitalized patients with heart failure

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Severe Ischemic Left Ventricular Systolic Dysfunction

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