30-day Heart Failure Readmission Research Articles

Direct Bilirubin, but not Indirect Bilirubin, is Associated with Short-term Adverse Events in HFpEF.

Abnormal live function tests have been identified as independent risk factors for ominous prognosis in patients with heart failure. However, most of the previous studies have failed to determine the contribution of direct bilirubin (DBIL) and indirect bilirubin (IBIL) separately. Hence, we aimed to explore whether DBIL or IBIL is correlated with the prognosis of heart failure with preserved ejection fraction (HFpEF). <p> Methods: A total of 19837 patients were hospitalized for HFpEF between January 2012 and January 2022 in Fuqing City Hospital affiliated with Fujian Medical University. The primary endpoint was in-hospital all-cause mortality. Secondary endpoints included in-hospital cardiovascular mortality and 30-day re-admission for heart failure. <p> Results: Univariable analysis indicated that patients with elevated DBIL or IBIL were exposed to a higher risk of mortality and re-admission. However, in multivariable models, both ln-transformed DBIL and TBIL, but not IBIL, were independent risk factors for in-hospital all-cause mortality [hazard ratio (HR)=1.796, 95% confidential interval (CI)=1.477-2.183, P＜0.001; HR=1.854, 95% CI=1.461-2.352, P＜0.001; HR=1.161, 95% CI=0.959-1.407, P=0.126] and in-hospital cardiovascular mortality (HR=1.831, 95% CI=1.345-2.492, P＜0.001; HR=1.899, 95% CI=1.300-2.773, P=0.001; HR=1.145, 95% CI=0.841-1.561, P=0.389). Only DBIL remained independently associated with 30-day readmission for heart failure (HR=1.361, 95% CI=1.036-1.787, P=0.027). Adding ln-transformed DBIL to model 1 increased its discriminatory capacity (C-statistic: 0.851 to 0.869, respectively), whereas adding ln-transformed IBIL yielded little increment (C-statistic: 0.851 to 0.852, respectively). <p> Conclusion: DBIL, but not IBIL, was associated with short-term ominous prognosis in patients with HFpEF. Hence, DBIL may be the superior predictor for prognosis in HFpEF.

Impact of care coordination on 30-day readmission, mortality, and costs for heart failure.

Although coordination of care has become the main focus of health care reform efforts to improve outcomes and decrease costs, limited information is available concerning the impact of care coordination on 30-day outcomes and costs. We used nationwide, population-based data to examine the influence of care coordination on 30-day readmission, mortality, and costs for heart failure (HF). We analyzed 20,713 patients with HF 18 years or older discharged from hospitals in 2016 using Taiwan's National Health Insurance Research Database. The coordination of care among a patient's outpatient physicians was measured with care density. Multilevel regression models were used after adjustment for patient and hospital characteristics to explore the impact of care density on 30-day readmission, mortality, and costs. Patients with high care coordination had lower odds of 30-day readmission (OR, 0.90; 95% CI, 0.82-0.98) and mortality (OR, 0.83; 95% CI, 0.70-0.99) and lower costs (cost ratio [CR], 0.84; 95% CI, 0.79-0.90) compared with those with low care coordination. Patients with medium care coordination had lower costs (CR, 0.92; 95% CI, 0.86-0.98) than those with low care coordination. High care coordination is associated with decreased 30-day readmission, mortality, and costs for HF. Enhancing coordination of care has the potential to increase the value of care. It is important to monitor coordination of care and develop strategies to maintain high levels of care coordination for HF.

Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair.

Transcatheter edge-to-edge mitral valve (MV) repair (TEER) is an effective treatment for patients with primary mitral regurgitation at prohibitive risk for surgical MV repair (MVr). High-volume MVr centers and high-volume TEER centers have better outcomes than low-volume centers, respectively. However, whether MVr volume predicts TEER outcomes remains unknown. We hypothesized that high-volume MV surgical centers would have superior risk-adjusted outcomes for TEER than low-volume centers. We combined data from the American College of Cardiology/Society of Thoracic Surgeons Transcatheter Valve Therapy registry and the Society of Thoracic Surgeons adult cardiac surgery database. MVr was defined as leaflet resection or artificial chords with or without annuloplasty and was evaluated as a continuous variable and as predefined categories (<25, 25-49, and ≥50 MV repairs/year). A generalized linear mixed model was used to evaluate risk-adjusted in-hospital/30-day mortality, 30-day heart failure readmission, and TEER success (mitral regurgitation ≤2+ and gradient <5 mm Hg). The study comprised 41 834 patients from 500 sites of which 332 (66.4%) were low, 102 (20.4%) intermediate, and 66 (13.2%) high-volume surgical centers (P<0.001). TEER success was 54.6% and was not statistically significantly different across MV surgical site volumes (P=0.4271). TEER mortality at 30 days was 3.5% with no significant difference across MVr volume on unadjusted (P=0.141) or adjusted (P=0.071) analysis of volume as a continuous variable. One-year mortality was 15.0% and was lower for higher MVr volume centers when adjusted for clinical and demographic variables (P=0.027). Heart failure readmission at 1 year was 9.4% and was statistically significantly lower in high-volume centers on both unadjusted (P=0.017) or adjusted (P=0.015) analysis. TEER can be safely performed in centers with low volumes of MV repair. However, 1-year mortality and heart failure readmission are superior at centers with higher MVr volume.

Abstract P155: Identifying Inpatient and Outpatient Factors That Reduce Heart Failure Exacerbation Readmissions

Acute heart failure 30-day readmissions are associated with increased patient morbidity and mortality. Our aim is to identify systemic factors that can reduce heart failure readmissions, including the implementation of a heart failure care coordination team. We assessed the hypothesis that individualized post-discharge education and summary from the heart failure care coordination team will reduce 30-day heart failure readmissions.This retrospective study included 213 patients, 18 years and older admitted with NYHA Class II-IV and ACC/AHA Stage B-D heart failure exacerbations from July 2021- March 2022, at a community hospital. Collected variables included demographics, medical comorbidities, labs, echocardiographic findings, inpatient orders, LACE index score, discharge follow-up, receipt of an after-visit summary, length of stay, and 30-day readmission. Descriptive data was summarized as counts and percentages for categorical data, and mean or median for continuous data. Between-group parametric data means were compared by calculating the t-test for independent variables, or medians using the Mann-Whitney U test for data that were nonparametric. Categorical variables were compared by calculating the chi-square test for association or Fisher’s exact test, as appropriate. The primary study objective was tested using Logistic regression modeling. Throughout this study, a p-value ≤0.05 (two-tail) was considered statistically significant. The medical records of all available reduced treatment plan patients were compared to preserved treatment plan patients in approximately equal numbers. Pair-wise t-tests required the greatest number of subjects. Using the conventional power level of 80%, a two-tailed alpha of 0.05, and assuming a medium effect size, it was estimated that this comparison will require at least 114 subjects. In this study, 189 of 213 patients were reached by the heart failure care coordination team. 49/189 were readmitted in 30 days and 140/189 were not. For the readmission group, the percentage of patients who were CKD Stage 3 or 4 (39.4%, 28 of 71) was higher than those who were not (21.1%, 30 of 142) with a p-value of 0.005. The percentage of patients who had discharge BNP checked (39.1%, 18 of 46) was higher than those who were not (24.1%, 40 of 166) with a p-value of 0.043. A higher LACE index score was associated with readmission as compared to a lower score, with a p-value of &lt; 0.001. In conclusion, presence of CKD stage 3 or 4, discharge BNP, and a higher LACE-index score were associated with 30-day heart failure readmission. Counterintuitively, the heart failure care coordination team did not have an impact on this endpoint, contrary to our hypothesis. Future studies with a larger sample size and focus on the outpatient care team efforts may be helpful in elucidating the team's potential in preventing heart failure readmission.

Machine Learning-Based 30-Day Readmission Prediction Models for Patients with Heart Failure: A Systematic Review.

Heart failure (HF) is one of the most frequent diagnoses for 30-day readmission after hospital discharge. Nurses have role in reducing unplanned readmission and providing quality of care during HF trajectories. This systematic review assessed the quality and significant factors of machine learning (ML)-based 30-day HF readmission prediction models. Eight academic and electronic databases were searched to identify all relevant articles published between 2013 and 2023. Thirteen studies met our inclusion criteria. The sample sizes of the selected studies ranged from 1,778 to 272,778 patients, and patients' average age ranged from 70 to 81 years. Quality appraisal was performed. The most commonly used ML approaches were Random Forest and XGBoost. The 30-day HF readmission rates ranged from 1.2% to 39.4%. The area under the receiver operating characteristic curve for models predicting 30-day HF readmission were between 0.51 and 0.93. Significant predictors included sixty variables with nine categories (socio-demographics, vital signs, medical history, therapy, echocardiographic findings, prescribed medications, laboratory results, comorbidities, and hospital performance index). Future studies using ML algorithms should evaluate the predictive quality of the factors associated with 30-day HF readmission presented in this review, considering different healthcare systems and type of HF. More prospective cohort studies with combining structured and unstructured data are required to improve the quality of ML based prediction model, which may help nurses and other healthcare professionals assess early and accurate 30-day HF readmission predictions and plan individualized care after hospital discharge. This study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42023455584).

A machine learning model to predict heart failure readmission: toward optimal feature set.

Hospital readmissions for heart failure patients remain high despite efforts to reduce them. Predictive modeling using big data provides opportunities to identify high-risk patients and inform care management. However, large datasets can constrain performance. This study aimed to develop a machine learning based prediction model leveraging a nationwide hospitalization database to predict 30-day heart failure readmissions. Another objective of this study is to find the optimal feature set that leads to the highest AUC value in the prediction model. Heart failure patient data was extracted from the 2020 Nationwide Readmissions Database. A heuristic feature selection process incrementally incorporated predictors into logistic regression and random forest models, which yields a maximum increase in the AUC metric. Discrimination was evaluated through accuracy, sensitivity, specificity and AUC. A total of 566,019 discharges with heart failure diagnosis were recognized. Readmission rate was 8.9% for same-cause and 20.6% for all-cause diagnoses. Random forest outperformed logistic regression, achieving AUCs of 0.607 and 0.576 for same-cause and all-cause readmissions respectively. Heuristic feature selection resulted in the identification of optimal feature sets including 20 and 22 variables from a pool of 30 and 31 features for the same-cause and all-cause datasets. Key predictors included age, payment method, chronic kidney disease, disposition status, number of ICD-10-CM diagnoses, and post-care encounters. The proposed model attained discrimination comparable to prior analyses that used smaller datasets. However, reducing the sample enhanced performance, indicating big data complexity. Improved techniques like heuristic feature selection enabled effective leveraging of the nationwide data. This study provides meaningful insights into predictive modeling methodologies and influential features for forecasting heart failure readmissions.

Gender differences in clinical features and outcomes of patients over 75 years presenting with acute heart failure. Results of a nationwide study (2016-2019).

Heart failure (HF) is a major health problem in Western countries, and a leading cause of hospitalizations and death. There is a scarcity of data on the influence of sex on HF outcomes in elderly patients. The aim of the present study was to analyze differences between men and women in clinical characteristics, in-hospital mortality, 30-day HF readmission rates, cardiovascular mortality and HF readmission rates at 1 year after discharge in patients older than 75 years hospitalized for HF in Spain. Retrospective analysis of patients discharged with a main diagnosis of HF from all Spanish public hospitals between 2016 and 2019. Patients aged 75 years or older were selected, and a comparison was made between male and female patients. From 2016 to 2019, a total of 354,786 episodes of HF in this age subgroup were identified, 59.2% being women. The overall mean age was 85.2 ± 5.4 years, being higher in women (85.9 ± 5.5 vs. 84.2 ± 5.3 years, p < 0.001). Risk-adjusted in-hospital mortality was lower in women (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.92-0.97; p < 0.001). Female sex also showed a protective effect for 30-day readmissions, with an OR of 1.06 (95% CI: 1.04-1.09; p < 0.001). One-year cardiovascular mortality (24.1% vs. 25.0%; p < 0.001) and one-year HF readmission rates (30.8% vs. 31.6%; p = 0.001) were lower in women. Almost 60% of hospital admissions for HF in people aged 75 years or older between 2016 and 2019 in Spain were female patients. Female sex seems to play a protective role on in-hospital mortality and the rate of admissions and mortality at 1 year after discharge.

Reduced Heart Failure 30-day Readmission With Implementation Of A Cohesive And Structured Nurse Practitioner Led Inpatient And Outpatient Heart Failure Disease Management Program

Reduced Heart Failure 30-day Readmission With Implementation Of A Cohesive And Structured Nurse Practitioner Led Inpatient And Outpatient Heart Failure Disease Management Program

Knowing the Patient: Understanding Readmission Reasons in Complex Heart Failure.

Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%). Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.

Trends and burden of decompensated valvular heart disease

Abstract Background The prevalence of valvular heart disease (VHD) is increasing. However, the incidence and burden of valve-related decompensation are unknown. This will have significant implications for the management of patients with VHD and healthcare provision. Purpose To evaluate the incidence and clinical and healthcare burden of valve-related decompensated. Methods Between 2016-2019, data on patients with decompensated heart failure was extracted from the US National Readmission Database. Patients were divided into valve-related and non-valve related decompensation based on the predominant pathology resulting in decompensation. ICD-10 codes were used to categorise and select patients. Comparisons between both cohorts was made regarding frequencies and clinical and healthcare burden. Fine-Gray hazards models were used to assess the incidence of outcomes. Results Of 5,369,433 patients with decompensated heart failure, 691,581 (12.9%) were due to valve-related decompensation. The incidence of valve-related decompensation increased from 154,572 patients in 2016 to 185,510 patients in 2019 (p&amp;lt;0.001). Patients with valve-related decompensation had a marginally longer hospital length of stay [4 (3-7) vs 4 (2-7)days; p&amp;lt;0.0001] and greater adjusted cost [$12,475 (6,923-27,189) vs 10,194 (6,121-19,569); p&amp;lt;0.0001] compared to non-valve related decompensation. Aortic valve disease was the most common cause of valve-related decompensation (47.6%), followed by mitral (39.4%), mixed valvular (10.0%) and tricuspid (3.0%) valve disease. Valve repair/replacement was performed during the index admission in 19%, 7%, 17% and 3% of patients respectively. Compared to non-valve related decompensation, 30-day heart failure readmission for aortic (HR: 1.03, 95% CI: 1.01-1.04; p&amp;lt;0.0001), mitral (HR: 1.61, 95% CI: 1.59-1.64; p&amp;lt;0.0001), mixed valvular (HR 1.77, 95% CI: 1.72-1.81; p&amp;lt;0.0001) and tricuspid valve disease (HR: 1.61, 95% CI: 1.53-1.69; p=0.004) was higher. Conclusions Valve-related decompensated heart failure is common, and its incidence is increasing. It places a significant burden on healthcare resources. In-patient valve repair/replacement is rarely performed for all valve types, especially tricuspid valve-related decompensation. Subsequently, heart failure readmission rates are higher. Strategies to reduce decompensation from valve disease are required in order to alleviate the clinical and healthcare burden associated with it.Table 1

Evaluation of Inpatient Sodium-Glucose Co-Transporter-2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure

Hospitalization for acute heart failure (HF) represents an important opportunity for initiation and up-titration of guideline-directed medical therapy. The objective of our study was to determine whether sodium-glucose co-transporter-2 inhibitor (SGLT2I) use was safe in patients hospitalized for acute HF and whether its use was associated with improved clinical outcomes. We conducted a single-center retrospective cohort study of adults hospitalized for acute HF with any ejection fraction and separated them into two matched groups based on inpatient SGLT2I use. Matching yielded 110 patients in the SGLT2I group and 110 patients in the control group. 101 patients (91.8%) in the SGLT2I group were treated with dapagliflozin, while 9 (8.2%) were treated with empagliflozin. Mean age was 71 years, 37.7% were female, 70.9% were White, 22.7% were Black, and 64.1% were Hispanic or Latino. Length of stay was 10 days in the SGLT2I group and 11 days in the control group (p=0.43). 2 patients (1.8%) in the SGLT2I group and 13 patients (11.8%) in the control group died within 30 days of discharge (hazard ratio, 0.15; 95% CI, 0.03 to 0.66; p=0.012). 17 patients (15.5%) in the SGLT2I group and 11 patients (10.0%) in the control group had an all-cause readmission within 30 days (hazard ratio, 1.58; 95% CI, 0.74 to 3.37; p=0.239). Meanwhile, 11 patients (10.0%) in the SGLT2I group and 3 patients (2.7%) in the control group had a HF readmission within 30 days (hazard ratio, 3.75; 95% CI, 1.05 to 13.44; p=0.042). Acute kidney injury (54.5% vs. 18.2%; p<0.001) and hypotension (12.7% vs. 2.7%; p=0.005) occurred significantly more frequently in the control group. In conclusion, SGLT2I use in patients hospitalized for acute HF was associated with decreased 30-day all-cause mortality and lower rates of acute kidney injury and hypotension; however, 30-day HF readmission increased.

Abstract 17404: Heart Failure Hospitalization Readmissions and Mortality on Cardiology versus Non-Cardiology Services in a U.S. Hospital System

Introduction: With the number of patients diagnosed with heart failure (HF) in the U.S. exceeding the number of cardiologists specialized to care for them, there is increasing reliance on non-cardiologists for treatment of acute decompensated heart failure (ADHF). Based on prior studies, there is concern that outcomes may be inferior under this circumstance. Hypothesis: Patients admitted with ADHF have lower 30-day readmissions when admitted to cardiology versus non-cardiology services. Methods: This was an observational, retrospective cohort study of 6885 patients with a primary diagnosis of ADHF based on ICD diagnosis-codes from 2015 to 2020. Data were retrieved from an EPIC-based registry with patients admitted to any of five network hospitals in a single health system. The registries were constructed through Clarity. Logistic regression adjusted for age, race, and gender was employed to distinguish differences in 30-day readmissions in those admitted with ADHF to cardiology vs. non-cardiology services. Results: Of the 6885 patients, 14% were admitted to cardiology, and 86% under non-cardiology services. The total cohort’s mean age was 69 (±15). The majority were White (71%) and male (54%). There was a statistically significant difference in mean age between cardiology services (68 [±14]) and non-cardiology services (69 [±15]) (p= 0.013). Black patients represented 15% of patients on cardiology services and 28% on non-cardiology services (p &lt;0.0001). There were more male patients on the cardiology services (64%) than the non-cardiology services (52%) (p &lt;0.0001). Unadjusted 30-day readmissions were lower for those admitted to cardiology vs. non-cardiology services (odds ratio 0.82 [95%CI: 0.67, 0.99, p=0.041]). Adjusted 30-day readmissions for those admitted to cardiology vs non-cardiology services were also lower (odds ratio 0.79 [95%CI: 0.65, 0.97, p=0.022). Conclusion: In this institutional electronic health record-based study, 30-day HF readmissions were found to be significantly lower in those admitted to cardiology vs. non-cardiology services. A future study to explore the variables contributing to these outcomes and to validate this data in a larger population is required.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

Abstract 12299: Sex Differences in the Outcomes of Patients With Heart Failure Undergoing Catheter Ablation for Atrial Fibrillation

Introduction: There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that outcomes of patients with HF undergoing AF ablation differ between males and females and tested this hypothesis using data from a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were then divided into two cohorts based on their sex. A multivariable logistic regression model was used to adjust for confounders. Results: A total of 21,439 patients with HF underwent AF ablation between 2016-2019, of which 8,103 had heart failure with preserved ejection fraction (HFpEF) [64.8% were females], and 13,336 had heart failure with reduced ejection fraction (HFrEF) [38.4% were females]. Crude outcomes are shown in Figure 1. After multivariate adjustment, among patients with HFrEF, females had a longer length of stay (adjusted mean difference (aMD): 0.55 (0.16-0.93) days longer, p&lt;0.01) along with lower odds of routine home discharge (adjusted odds ratio (aOR):0.62; 95% confidence interval (CI):0.55-0.70; p&lt;0.01). Females had similar odds of in-hospital mortality, procedural complications, and 30-day/ 180-day all-cause, heart failure, and arrhythmia-related readmissions as compared to males. Among patients with HFpEF, females had higher odds of 30-day (aOR: 1.91; 95% CI: 1.24-2.93; p&lt;0.01) and 180-day heart failure readmissions (aOR: 1.53; 95% CI: 1.04-2.28; p=0.03) along with lower odds of routine home discharge (aOR:0.67; 95% CI: 0.57-0.78; p&lt;0.01), as compared to males. Conclusion: In conclusion, our results show that females with HFrEF undergoing AF ablation have similar odds of in-hospital/30-day/180-day outcomes whereas females with HFpEF have higher odds of 30-day/180-day HF readmissions, as compared to males.

Abstract 16307: Does the Method of Calculating the 30-day Readmission Rate After Hospitalization for Heart Failure Matter? Data From the VancOuver CoastAL Acute Heart Failure Registry

Introduction: The 30-day readmission rate after a heart failure (HF) hospitalization is widely used for assessing healthcare quality and system performance. However, there are different methodological approaches which may influence estimated rates, and no single accepted approach. The combined impact of these methods is unknown. Goals: We calculated 30-day HF readmission rates (RRs) of hospitalized patients using different published approaches to sampling and measurement. Methods: We included 1,849 patients discharged following unplanned hospitalization with a primary diagnosis of HF between 2016 to 2018 from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. We combined five distinct methodological factors (Table 1) to create 64 unique definitions and associated HF RRs. The readmission rates were averaged over 3-years. Multiple linear regression was used to determine the impact of different factors on estimated readmission rates. Results: The calculated 30-day RR for HF varied more than twofold depending solely on the methodological approach (6.4% to 15.0%, 8.6% absolute difference, 134% relative difference). The rates were highest when including all consecutive index admissions (11.1% to 15.0%), and lowest including only one index admission per patient per year (6.4% to 11.4%). The regression model ranked variables affecting RR as: index selection method, reference period, ICD-10 codes, 30-day survival, and index day (Table 2, p&lt;0.001 in all). Conclusions: Our findings have important implications for policy and reporting. Transparent and consistent methods are needed to calculate 30-day RRs to ensure reproducible and comparable reporting.

Management and Outcomes of Acute Heart Failure Hospitalizations in Japan.

Heart failure (HF) is a global burden on healthcare systems, but the literature regarding nationwide trends in the care and outcomes of HF hospitalization in Japan is limited. Therefore, we aimed to investigate the trends in patient characteristics, treatment patterns, and outcomes of patients hospitalized with acute HF.Methods and Results: We used data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination database between April 2012 and March 2021 to analyze 840,357 patients aged ≥18 years who were hospitalized with an acute HF diagnosis. Over the study period (2012-2020), the mean (±standard deviation) age increased from 78.9 (±11.9) years to 80.9 (±11.8) years (P for trend <0.001), the proportion of female patients decreased from 48.7% to 47.5% (P for trend=0.02), crude in-hospital mortality rate decreased from 11.5% to 10.9%, and 30-day HF readmissions decreased from 7.4% to 7.0% (both P for trend <0.001). The reduction in outcomes was more apparent in the older age groups. The standardized outcomes demonstrated the same trends as the crude outcomes. Our nationwide hospital admission analysis clarified that patients hospitalized with acute HF were getting older, but mortality and readmission rates also decreased, especially in older patients during the 2010s.

Development and Validation of a Machine Learning Risk-Prediction Model for 30-Day Readmission for Heart Failure Following Transcatheter Aortic Valve Replacement (TAVR-HF Score)

Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis across the spectrum of surgical risk. About one-third of 30-day readmissions following TAVR are related to heart failure (HF). Hence, we aim to develop an easy-to-use clinical predictive model to identify patients at risk for HF readmission. We used data from the National Readmission Database (2015-2018) utilizing ICD-10 codes to identify TAVR procedures. Readmission was defined as the first unplanned HF readmission within 30-day of discharge. A machine learning framework was used to develop a 30-day TAVR-HF readmission score. The receiver operator characteristic curve was used to evaluate the predictive power of the model. A total of 92,363 cases of TAVR were included in the analysis. Of the included patients, 3299 (3.6%) were readmitted within 30 days of discharge with HF. Individuals who got readmitted, vs those without readmission, had more emergent admissions during index procedure (33.4% vs 19.8%), electrolyte abnormalities (38% vs 16.7%), chronic kidney disease (34.8% vs 21.2%), and atrial fibrillation (60.1% vs 40.7%). Candidate variables were ranked by importance using a parsimony plot. A total of 7 variables were selected based on predictive ability as well as clinical relevance: HF with reduced ejection fraction (25 points), HF preserved EF (20 points), electrolyte abnormalities (17 points), atrial fibrillation (12 points), Charlson comorbidity index (<6 = 0, 6-8 = 9, 9-10 = 13, >10 = 14 points), chronic kidney disease (7 points), and emergent index admission (5 points). On performance evaluation using the testing dataset, an area under the curve of 0.761 (95% CI 0.744-0.778) was achieved. Thirty-day TAVR-HF readmission score is an easy-to-use risk prediction tool. The score can be incorporated into electronic health record systems to identify at-risk individuals for readmissions with HF following TAVR. However, further external validation studies are needed.

The Relationship Between Accurate Triage and Core Measures Compliance for Acute Myocardial Infarction and Heart Failure in Older Adults Presenting to the Emergency Department.

Accurate emergency department (ED) triage in the geriatric population is an important nurse-sensitive quality indicator; however, few quality indicators are verified for impact. To examine the relationship between triage accuracy in adults older than 65 years and Core Measures for acute myocardial infarction (AMI) and heart failure (HF). A correlational approach was used to determine strength and direction of the relationship between variables. Strong positive correlations were found between triage accuracy and mortality for AMI and HF, as well as with 30-day hospital readmissions for AMI. A weak negative correlation was found between triage accuracy and 30-day hospital readmissions for HF. Accurate triage can lead to a more effective care trajectory for patients, better adherence to Core Measures, and better outcomes. Accuracy in triage for AMI and HF is a valid indicator of ED quality care.

Adapting evidence-informed peri-discharge complex interventions in reducing 30-day hospital readmissions for heart failure and COPD

ObjectiveTo select and refine evidence-informed peri-discharge complex interventions(abbrev. Interventions) for reducing 30-day hospital readmissions among Heart Failure(HF) and COPD patients in Hong Kong public healthcare system context using GRADE Evidence to Decision(EtD) framework. MethodsTwo 18-participant panels were recruited to carry out a two-step process for both conditions. In Step 1, participants were invited to prioritize Interventions and suggest important combinations of Interventions. In Step 2, based on the priority lists, participants were invited to conduct a two-round Delphi study for generating consensus-based Interventions for reducing 30-day hospital readmissions. GRADE EtD framework was used to guide the decision-making process, taking into consideration of benefits, harms, values and preferences, equity, acceptability, and feasibility. ResultsFive out of ten Interventions reached positive consensus for HF, while six reached positive consensus for COPD. Case management, discharge planning, patient education, self-management, and telephone follow-up were common components, and were considered as core elements for reducing 30-day hospital readmissions among HF and COPD patients in Hong Kong. Preliminary implementation issues mainly included governance and leadership, financing, health workforce development, service access and readiness, as well as empowerment of patients and caregivers. ConclusionsThis study successfully applied the GRADE EtD framework for starting the adaptation process of complex interventions and established a list of local stakeholders-endorsed Interventions for reducing 30-day hospital readmissions for HF and COPD in Hong Kong. Before implementing and maintaining these endorsed Interventions at scale in local context, further research to improve intervention-context fit as well as piloting and evaluation is necessary.

Evaluation Of Post-acute Follow-up On 30-day Heart Failure Readmission Rate In Patients With And Without Dialysis-dependent End Stage Renal Disease

Evaluation Of Post-acute Follow-up On 30-day Heart Failure Readmission Rate In Patients With And Without Dialysis-dependent End Stage Renal Disease