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Hierarchical analysis of factors associated with hospital readmissions for coronary heart disease: A case-control
Nila Larisse Silva de Albuquerque1, Thelma Leite de Araujo1, Marcos Venicios de Oliveira Lopes1
1Department of Nursing, Federal University of Ceara, Fortaleza, Brazil.
Insights
Hospital readmissions for acute coronary syndrome are linked to poor medication adherence, smoking history, stress, and infrequent primary care use. Addressing these factors can significantly reduce readmission rates.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Hospital readmissions are increasing, particularly for patients with chronic conditions like acute coronary syndrome (ACS).
- ACS readmissions are costly and often preventable, necessitating identification of key risk factors.
- Understanding clinical and non-clinical variables is crucial for managing patients with coronary heart disease.
Purpose of the Study:
- To hierarchically analyze factors associated with hospital readmissions for acute coronary syndrome.
- To identify key predictors of readmission in ACS patients.
- To develop a predictive model for ACS readmissions.
Main Methods:
- A case-control study involving 277 inpatients with acute coronary syndrome.
- Data collected through interviews, anthropometric measurements, and patient records.
- Hierarchical logistic regression analysis using R software, adhering to STROBE guidelines.
Main Results:
- Inadequate drug therapy adherence was a significant risk factor for ACS readmission.
- Stress, a smoking history of 30+ years, and lack of primary healthcare use were also associated with higher readmission rates.
- These clinical and non-clinical variables can increase readmission risk up to sixfold.
Conclusions:
- Clinical and non-clinical factors significantly influence hospital readmissions for acute coronary syndrome.
- A predictive model for ACS readmissions offers an advancement in outcome prediction.
- Post-discharge care networks require reorientation to prevent readmissions after initial ACS hospitalization.
Aims And Objectives:
To analyse, hierarchically, factors associated with hospital readmissions for acute coronary syndrome.
Background:
Hospital readmissions have risen, especially in patients with multiple comorbidities, which are most often chronic. The leading causes of hospital readmission include acute coronary syndrome, which is costly and often preventable. Determining clinical and nonclinical variables that increase the chances of readmission is important to assess and evaluate patients hospitalised for coronary heart diseases.
Design:
A case-control study whose dependent variable was hospital readmission for acute coronary syndrome.
Methods:
The study included 277 inpatients, of whom 132 were in their first hospitalisation and 145 had already been hospitalised for acute coronary syndrome. The independent variables for this hierarchical model were sociodemographic conditions, life habits, access to health services and physical health measures. Data were obtained by interviews, anthropometric measurements and patient records. Logistic regression analysis was performed using the stepwise technique, with Microsoft Excel and R version 3.2.3. The research was reported via strengthening the reporting of observational studies in epidemiology (STROBE).
Results:
In the final hierarchical logistic model, the following risk factors were associated with readmission for acute coronary syndrome: inadequate drug therapy adherence, stress, history of smoking for 30 years or more, and the lack of use of primary healthcare services.
Conclusions:
Clinical and nonclinical variables are related to hospital readmission for acute coronary syndrome and can increase the chance of readmission by up to six times.
Relevance To Clinical Practice:
The predictive model can be used to avoid readmission for acute coronary syndrome, and it represents an advance in the prediction of the occurrence of the outcome. This implies the need for a reorientation of the network for postdischarge care in the first hospitalisation for acute coronary syndrome.
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