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[Predictors of readmission in patients with congestive heart failure]
P Castro1, V Bittner, L Villarroel
1Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile. pcastro@osler.med.puc.cl
Insights
Patients with congestive heart failure (CHF) experiencing ischemia, advanced symptoms, renal dysfunction, or continuing to smoke face higher readmission risks. Identifying these high-risk individuals for intensive outpatient intervention is crucial.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Context:
- Repeated hospitalizations are common in patients with congestive heart failure (CHF).
- Understanding readmission predictors is vital for effective patient management and resource allocation.
- This study focuses on identifying factors contributing to CHF readmissions.
Purpose:
- To determine predictors of hospital readmission in patients diagnosed with congestive heart failure (CHF).
- To identify specific clinical and demographic factors associated with increased risk of CHF readmission.
Summary:
- This retrospective study analyzed 237 patients hospitalized with CHF. Key predictors of readmission included myocardial ischemia, advanced NYHA class (III/IV), elevated creatinine at discharge, and continued smoking.
- Factors associated with decreased readmission risk were history of coronary artery bypass grafting (CABG).
- Demographics and insurance status did not predict readmission, while diabetes mellitus and lower ejection fraction were more frequent in readmitted patients but not predictive.
Impact:
- Identifies high-risk CHF patient profiles (ischemia, advanced symptoms, renal dysfunction, smoking) for targeted interventions.
- Suggests the need for intensive outpatient management for patients identified with these risk factors prior to discharge.
- Provides evidence to guide clinical decision-making and improve post-discharge care for CHF patients to reduce readmissions.
Unlabelled:
Repeated hospitalizations among patients (pts) with congestive heart failure (CHF) are common.
Purpose:
This retrospective study was designed to determine predictors of readmission.
Inclusion Criteria:
admitted to University Hospital with a primary diagnosis of CHF between 10/1/94-9/30/95: lived in Jefferson county.
Exclusions:
cardiac transplant during study period; major comorbidity (e.g. malignancy, advanced renal failure). Predictors of readmission were determined by stepwise logistic regression analysis and predictor of time to readmission with Cox Proportionate Hazards modeling p < 0.05 was considered statistically significant.
Results:
Mean age of the 237 pts was 66.5 yrs; 56% women. Mean left ventricular ejection fraction (LVEF) was 29%; 96% were in NYHA class III/IV. Mean length of stay was 5 days; 52 pts (22%) had > 1 admission. CHF etiologies: Ischemic (42%), hypertensive (37%), idiopathic (12%). Demographic characteristics and insurance status did not predict readmission risk. Predictors of readmission in the logistic and Cox models were similar. Increased risk of readmission was associated with myocardial ischemia (logistic OR 42.7), past NYHA Class III and IV (OR 32.8), plasmatic creatinine at discharge (OR 1.9) and continued smoking (OR 3.26). History of CABG was associated with a decreased risk of rehospitalization (OR 0.12). Beta-blocker use was associated with decreased risk, but did not achieve statistical significance. ACE-I use (prescribed in 78% of pts), did not contribute to the model. Diabetes Mellitus and a lower LVEF were more frequent in the readmitted group, but they did not predict readmission.
Conclusion:
CHF pts who have evidence of ischemia, advanced symptoms, renal dysfunction, and who continue to smoke are at increased risk for hospital readmission. Pts with these characteristics should be identified prior to hospital discharge and considered for intensive outpatient intervention.