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Comorbidities in heart failure patients that predict cardiovascular readmissions within 100 days-An observational
Mia Scholten1, Jason Davidge1,2, Björn Agvall1,3
1Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Lund, Sweden.
Insights
Heart failure patients with atrial fibrillation, chronic kidney disease, or chronic obstructive pulmonary disease face higher readmission risks. However, these comorbidities alone do not fully predict readmission, indicating other factors are crucial.
Area of Science:
- Cardiology
- Public Health
- Geriatrics
Background:
- Heart failure (HF) is a common complication of cardiovascular diseases, often accompanied by comorbidities.
- These comorbidities significantly impact HF patient outcomes and hospital readmissions.
- Understanding comorbidity influence on HF readmission is vital for improving patient care.
Purpose of the Study:
- To analyze the impact of specific comorbidities on cardiovascular-related readmission risk within 100 days post-discharge in HF patients.
- To identify which comorbidities independently predict increased readmission rates.
- To evaluate the predictive power of comorbidities for HF readmission.
Main Methods:
- A population-based retrospective study of 5029 HF patients (2017-2019).
- Competing risk regression and logistic regression analyzed 10 common comorbidities and their association with 100-day readmission.
- Receiver operating characteristic (ROC) and area under curve (AUC) assessed model predictive performance.
Main Results:
- Atrial fibrillation, COPD, CKD, PAD, and diabetes mellitus were initially associated with increased readmission HR.
- After adjustment, only atrial fibrillation, CKD, and COPD remained significant predictors of readmission.
- Logistic regression models incorporating comorbidities showed low AUC, indicating limited predictive power.
Conclusions:
- Atrial fibrillation, chronic kidney disease, and chronic obstructive pulmonary disease are significantly linked to higher readmission risk in heart failure patients.
- The low AUC from ROC analysis suggests that these comorbidities alone are insufficient predictors of readmission.
- Further research should explore additional factors contributing to HF readmission risk.
Background:
Heart failure (HF) commonly arises as a complication to cardiovascular diseases and is closely associated with various comorbidities. The impacts of these comorbidities in patients with HF are diverse. We aimed to analyze the increased risk for cardiovascular-related readmission within 100 days after discharge in patients with HF depending on their different comorbidities.
Methods:
A population-based retrospective study was conducted in Region Halland with 5029 patients admitted to hospital with a diagnosis of HF during 2017-2019. The occurrence and number of comorbidities were recorded. Competing risk regression was employed to analyze the hazard ratio (HR) of 10 comorbidities for cardiovascular-related readmission within 100 days after discharge. A composite measure of the 10 common comorbidities was constructed with the comorbidities as dichotomous indicator variables and Rasch analysis. Receiver operating characteristic (ROC) and area under curve (AUC) after logistic regression were used to estimate how well the model explained the probability of death or readmission within 100 days after discharge according to their individual comorbidity level.
Results:
HF patients with atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, peripheral artery disease or diabetes mellitus as comorbidities had an increased HR for readmission within 100 days after discharge. When these comorbidities were adjusted together, only atrial fibrillation, chronic kidney disease and chronic obstructive pulmonary disease had an increased HR for readmission. ROC analysis after the most complete models using logistic regression with the comorbidities as dichotomous indicator variables or Rasch analysis had a low AUC.
Conclusions:
Atrial fibrillation, chronic kidney disease or chronic obstructive pulmonary disease were significantly associated with increased risk for readmission in HF patients, but ROC analysis showed a low AUC, which indicates that other factors are more important for predicting the increased risk of readmission.
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