High readmission rate after heart valve surgery: A nationwide cohort study

Abstract

BackgroundAfter heart valve surgery, knowledge on long-term self-reported health status and readmission is lacking. Thus, the optimal strategy for out-patient management after surgery remains unclear. MethodsUsing a nationwide survey with linkage to Danish registers with one year follow-up, we included all adults 6–12months after heart valve surgery irrespective of valve procedure, during Jan–June 2011 (n=867). Participants completed a questionnaire regarding health-status (n=742), and answers were compared with age- and sex-matched healthy controls. Readmission rates and mortality were investigated. ResultsAfter valve surgery, the self-reported health was lower (Short Form-36 (SF-36) Physical Component Scale (PCS): 44.5 vs. 50.6 and Mental Component Scale (MCS): 51.9 vs. 55.0, p<0.0001) and more were physically sedentary compared with healthy controls (11.1% vs. 15.2%). Clinical signs of anxiety and depression were present in 13.6% and 13.8%, respectively (Hospital Anxiety and Depression Scale score≥8). Twelve months following discharge, 483 persons (56%) were readmitted. Readmission was associated with lower self-reported health (SF-36 PCS: 46.5 vs. 43.9, and MCS 52.2 vs. 50.7). Higher age (hazard ratio (95% CI): 1.3 (1.0–1.6)), male sex (1.2 (1.0–1.5)), mitral valve surgery (1.3 (1.0–1.6)), and infective endocarditis after surgery (1.8 (1.1–3.0), p: 0.01) predicted readmission, whereas higher age (2.3 (1.0–5.4)), higher comorbidity score (3.2 (1.8–6.0)), and infective endocarditis after surgery (3.2 (1.2–8.9)) predicted mortality. Conclusions6–12months after heart valve surgery the readmission rate is high and the self-reported health status is low. Readmission is associated with low self-reported health. Therefore, targeted follow-up strategies post-surgery are needed.