Abstract
Background and objectives:Data on population-level outcomes after heart failure (HF) hospitalisation in Asia is sparse. This study aimed to estimate readmission and mortality after hospitalisation among HF patients and examine temporal variation by sex and ethnicity.Methods:Data for 105,399 patients who had incident HF hospitalisations from 2007 to 2016 were identified from a national discharge database and linked to death registration records. The outcomes assessed here were 30-day readmission, in-hospital, 30-day and one-year all-cause mortality.Results:Eighteen percent of patients (n = 16786) were readmitted within 30 days. Mortality rates were 5.3% (95% confidence interval (CI) 5.1–5.4%), 11.2% (11.0–11.4%) and 33.1% (32.9–33.4%) for in-hospital, 30-day and 1-year mortality after the index admission. Age, sex and ethnicity-adjusted 30-day readmissions increased by 2% per calendar year while in-hospital and 30-day mortality declined by 7% and 4% per year respectively. One-year mortality rates remained constant during the study period. Men were at higher risk of 30-day readmission (adjusted rate ratio (RR) 1.16, 1.13–1.20) and one-year mortality (RR 1.17, 1.15–1.19) than women. Ethnic differences in outcomes were evident. Readmission rates were equally high in Chinese and Indians relative to Malays whereas Others, which mainly comprised Indigenous groups, fared worst for in-hospital and 30-day mortality with RR 1.84 (1.64–2.07) and 1.3 (1.21–1.41) relative to Malays.Conclusions:Short-term survival was improving across sex and ethnic groups but prognosis at one year after incident HF hospitalisation remained poor. The steady increase in 30-day readmission rates deserves further investigation.
Highlights
As it is in high-income countries, heart failure (HF) is already demonstrated to be a major burden in middleincome countries and this is expected to pose an equal, if not greater financial and morbidity impact as some of these countries are still grappling with a concurrent infectious disease burden [4]
We described the temporal variation in these outcomes by sex and ethnicity in this ethnically diverse country
We reported crude readmission and mortality rates stratified by age, sex and ethnicity
Summary
On the individual patient level, knowing the absolute risks of mortality and readmission enables shared decision-making between health providers and patients when making plans for disease management [3]. As it is in high-income countries, HF is already demonstrated to be a major burden in middleincome countries and this is expected to pose an equal, if not greater financial and morbidity impact as some of these countries are still grappling with a concurrent infectious disease burden [4]. Recent data from Malaysia, a middle-income country in Southeast Asia, has shown a 39% rise in the absolute number of incident HF hospitalisations from 2007 to 2016 (Su Miin Ong, MSc, unpublished data, 2020) This highlights an urgent need to fill the existing gaps on temporal trends for clinical outcomes, for Asia [4]. This study aimed to estimate readmission and mortality after hospitalisation among HF patients and examine temporal variation by sex and ethnicity
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