Abstract
BACKGROUND: There have been previous studies detailing the variables involved in readmissions in patients with a primary admission diagnosis of infective endocarditis – however those studies were done prior to the 2015 change in AHA guidelines and introduction to ICD-10 codes. OBJECTIVES: The aim of this study was to describe the frequency, causes, factors, and costs associated with infective endocarditis encounters. METHODS: Utilizing the 2017 national readmission database (NRD), we identified all patients that were admitted with infective endocarditis. These patients were evaluated for the rates, predictors, and costs of unplanned 30 days readmissions. Weighted analysis was performed to obtain nationally representative data. RESULTS: 56,357 patients were identified to have been admitted with a diagnosis of infective endocarditis of whom 13,004 patients (23%) were readmitted within 30 days of the index discharge. The most common causes of readmission were septicemia (15.1%), endocarditis and endocardial disease (10.5%), heart failure (9.5%), and complication of cardiovascular device, implant or graft, initial encounter (5.6%). Data showed that there were certain comorbidities that resulted in a higher risk of being readmitted, these include chronic kidney disease, COPD, tobacco use, and hepatic failure. Cost of readmissions per patient was approximately $22,059 (IQR $11,630 - $49,964). CONCLUSIONS: Thirty-day unplanned readmissions remain a significant issue affecting nearly 1 in 6 patients with infective endocarditis. This is associated with significant mortality and financial burden. Multi-disciplinary approach may help decrease readmissions, reduce complications, and improve overall outcomes as well as the overall quality of life of our patients.
Highlights
Despite a low incidence rate of 3-10 individuals per 100 person-years, infection of the endocardium and/or heart valves, known as Infective Endocarditis (IE) is a potentially lethal process associated with significant mortality and morbidity [1].The mortality rate of IE is alarmingly high as detailed in a prior study with in-hospital rates of up to 20% and a 1-year mortality rate of up to 40% [1]
We identified those patients diagnosed with infective endocarditis using a weighted analysis
Compared with the patients who were not readmitted within 30 days, those readmitted were more likely to have comorbidities chronic kidney disease, COPD, and tobacco use disorder
Summary
Despite a low incidence rate of 3-10 individuals per 100 person-years, infection of the endocardium and/or heart valves, known as Infective Endocarditis (IE) is a potentially lethal process associated with significant mortality and morbidity [1].The mortality rate of IE is alarmingly high as detailed in a prior study with in-hospital rates of up to 20% and a 1-year mortality rate of up to 40% [1]. With the advent of ICD-10, the complexity of diagnosis/coding has increased multi-fold, which provides greater specificity to the research and more ability to pinpoint factors that may alter management [4]. This in addition to updated practice patterns with updated society guidelines, we evaluated large real-world data from the Nationwide Readmissions Database (NRD), to understand comorbidities and predictors associated with early unplanned readmissions in patients discharged with IE. There have been previous studies detailing the variables involved in readmissions in patients with a primary admission diagnosis of infective endocarditis – those studies were done prior to the 2015 change in AHA guidelines and introduction to ICD-10 codes
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