Abstract
BackgroundThe incidence and 30-day readmission rates of patients with infective endocarditis (IE) are not fully determined. We used the United States Nationwide Readmission Database (NRD) to assess national trends and predictors of 30-day readmission.MethodsWe queried the NRD from 2010 to 2014 and identified patients with index hospitalizations primarily for IE. Univariate and multivariate logistic regression analyses were conducted to identify predictors of 30-day readmission.ResultsA total of 48,500 patients (mean age 58 ± 19 years; 38% women; 6.4% died during index hospitalization) were admitted for IE. There was an annual decrease in hospitalization rates by 1.5%. With an exception for 2014, subsequent 30-day readmission rates remained relatively unchanged. All-cause 30-day readmission occurred in 25.4% of patients, 21.8% of which were due to acute or subacute bacterial endocarditis. Leaving against medical advice (odds ratio (OR): 3.46, 95% CI: 3.12 - 3.84; P <0.001), history of drug abuse and a cardiac implantable electronic device in situ (OR: 2.17, 95% CI: 1.53 - 3.08; P <0.001), fungal IE (OR: 1.5, 95% CI: 1.28 - 1.76; P < 0.001), and uninsured patients (OR: 1.39, 95% CI: 1.12 - 1.74, P <0.001) were the strongest independent predictors of 30-day readmission. Readmission cost ($58 million annually) accounted for 14% of the total hospitalization cost.ConclusionsThe annual incidence of IE in the US decreased slightly from 2010 to 2014, but the 30-day readmission rates remained relatively unchanged. Addressing modifiable predictors of readmission may reduce the financial burden of IE on health care.
Highlights
Infective endocarditis (IE) is a lethal disease, with nearly 25% mortality at six months [1] and 18% within one year of discharge from index hospitalization [2]
All-cause 30-day readmission occurred in 25.4% of patients, 21.8% of which were due to acute or subacute bacterial endocarditis
Leaving against medical advice (odds ratio (OR): 3.46, 95% CI: 3.12 - 3.84; P
Summary
Infective endocarditis (IE) is a lethal disease, with nearly 25% mortality at six months [1] and 18% within one year of discharge from index hospitalization [2]. A study from the Danish registry in 2011 demonstrated high rates of readmission to the hospital (65%) among IE patients, with the majority (85%) readmitted within one year following discharge [2]. Whether these alarming numbers are specific to the Danish population or whether national trends across the United States mirror them remains unsettled. Due to the paucity of large-scale studies, we conducted the present analysis to assess the trends in incidence of IE admissions, the 30-day readmission rates after index hospitalizations, and the predictors and costs associated with readmissions in the United States using the Nationwide Readmissions Database (NRD). We used the United States Nationwide Readmission Database (NRD) to assess national trends and predictors of 30-day readmission
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