30-day Risk Of Hospitalization Research Articles

Efficacy and safety of early ferric carboxymaltose treatment in patients with acute decompensated heart failure

BACKGROUND: The efficacy of intravenous ferric carboxymaltose (FCM) therapy in heart failure (HF) with low ejection fraction with iron deficiency (ID) or ID anemia is known. The aim of this study was to determine the efficacy and safety of intravenous FCM therapy in the early decompensated period in acute decompensated HF with low ejection fraction with ID or ID anemia.METHODS: Patients with acute decompensated HF with low ejection fraction (EF<40%) with ID or ID anemia were included in the study. ID was diagnosed according to serum ferritin and transferrin saturation (TSAT) measurement at admission in 26 patients and before discharge in 26 patients, and intravenous FCM treatment was given at the same time. ID was defined as serum ferritin <100 μg/L (absolute ID) or ferritin 100-299 μg/L with a TSAT<20% (functional ID). Cox regression analysis was used to determine the relationship between the time of intravenous iron therapy and the risk of 30-day hospitalization and 6-month rehospitalization and mortality and Linear regression analysis was used for N-terminal pro-brain natriuretic peptide (NT-proBNP) change at 30 days.RESULTS: All patients have either ID or ID anemia. The mean age was 67.0±13.0 years, 58% female. Anemia was more prevalent at admission blood samples than before discharge (P<0.001), and absolute and functional iron deficiency rates were similar (P=0.38 and P=0.19, respectively). 30-day rehospitalization (Hazar ratio [HR]= 0.80, confidence interval [CI] 0.22-2.98, P=0.74) Sixth-month rehospitalization (HR=0.89, CI 0.36-2.20, P=0.80) and Sixth-month mortality (HR=0.51, CI 0.05-5.56, P=0.58) were similar between treatment groups. There was no significant relationship between the time of administration of FCM treatment and the change in pro-BNP levels measured at baseline and 30-day (P=0.90).CONCLUSIONS: In patients with acute decompensated HF with low ejection fraction and ID or ID anemia, the efficacy and safety of intravenous iron therapy applied at admission are similar to before discharge.

Baclofen has a risk of encephalopathy in older adults receiving dialysis

At least 23 case reports link the muscle relaxant baclofen to encephalopathy in patients receiving dialysis. To explore this issue, we conducted a study to quantify the risk of encephalopathy from baclofen in patients receiving dialysis. Linked healthcare databases were used to conduct a population-based cohort study of older adults receiving maintenance dialysis in Ontario, Canada (1997-2018) to compare new users of baclofen to non-users. The primary outcome was the 30-day risk of hospitalization with encephalopathy, defined as a main diagnosis of delirium, disorientation, transient alteration of awareness, or transient cerebral ischemic attack. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on indicators of baseline health. Weighted risk ratios (RR) were obtained using modified Poisson regression and weighted risk differences (RD) using binomial regression. We studied 360 new baclofen users and 6109 non-users (2638 [41%] women; median age 75). The median baclofen dose was 20 mg/day. Hospitalization with encephalopathy occurred in 26 of 360 baclofen users (7.2%) and in under six of 6109 non-users (under 0.1%); weighted risk ratios, 78.3 (95% confidence interval 27.9 to 219.2); weighted risk differences, 7.1% (4.5% to 9.8%). The median time from baclofen dispensing to hospitalization with encephalopathy was three days. Among patients receiving dialysis, approximately one in 14 were hospitalized with encephalopathy shortly after starting baclofen. Thus, baclofen should be avoided in older adults receiving dialysis, and other muscle relaxants considered in its place. Hence, if baclofen must be used, a low dose should be prescribed, and older adults should be carefully monitored for signs of encephalopathy.

Atypical antipsychotic medications and hyponatremia in older adults: a population-based cohort study.

BackgroundA number of case reports have suggested a possible association between atypical antipsychotic medications and hyponatremia. Currently, there are no reliable estimates of hyponatremia risk from atypical antipsychotic drugs.ObjectiveThe objective of this study was to examine the 30-day risk of hospitalization with hyponatremia in older adults dispensed an atypical antipsychotic drug relative to no antipsychotic use.DesignThe design of this study was a retrospective, population-based cohort study.SettingThe setting of this study was in Ontario, Canada, from 2003 to 2012.PatientsAdults 65 years or older with an identified psychiatric condition who were newly dispensed risperidone, olanzapine, or quetiapine in the community setting compared to adults with similar indicators of baseline health who were not dispensed such a prescription.MeasurementsThe primary outcome was the 30-day risk of hospitalization with hyponatremia. The tracer outcome (an outcome that is not expected to be influenced by the study drugs) was the 30-day risk of hospitalization with bowel obstruction. These outcomes were assessed using hospital diagnosis codes.MethodsUsing health administrative data, we applied a propensity score technique to match antipsychotic users 1:1 to non-users of antipsychotic drugs (58,008 patients in each group). We used conditional logistic regression to compare outcomes among the matched users and non-users.ResultsA total of 104 baseline characteristics were well-balanced between the two matched groups. Atypical antipsychotic use compared to non-use was associated with an increased risk of hospitalization with hyponatremia within 30 days (86/58,008 (0.15 %) versus 53/58,008 (0.09 %); relative risk 1.62 (95 % confidence interval (CI) 1.15 to 2.29); absolute risk increase 0.06 % (95 % CI 0.02 to 0.10)). The limited number of events precluded some additional analyses to confirm if the association was robust. Atypical antipsychotic use compared to non-use was not associated with hospitalization with bowel obstruction within 30 days (55/58,008 (0.09 %) versus 44/58,008 (0.08 %); relative risk 1.25 (95 % CI 0.84 to 1.86)).LimitationsWe could only study older adults within our data sources.ConclusionsIn this study, the use of an atypical antipsychotic was associated with a modest but statistically significant increase in the 30-day risk of a hospitalization with hyponatremia. The association was less pronounced than that described with other psychotropic drugs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-016-0111-z) contains supplementary material, which is available to authorized users.

The Relationships Between Vascular Risk, Cognition and Outcome in Late-Life Psychotic Depression

difficulties, and baseline depression scores. We assessed risk of discharge to hospital (according to Medicare hospitalization claims) in the 30-day and 60-day periods following start of care. Results: Of 755 total eligible patients, 195 (25.8%) patients were hospitalized during the 60-day study period. At 30 days from start of care, 68 (15.5%) CAREPATH patients and 69 (22.0%) usual care patients were hospitalized. The 30-day risk of hospitalization among CAREPATH patients was approximately 30% lower compared to usual care (adjusted Relative Risk (RR) 1⁄4 0.70, p1⁄4.020). At 60 days from start of care, 103 (23.5%) CAREPATH patients were hospitalized and 92 (29.4%) usual care patients were hospitalized. The 60-day risk of hospitalization remained approximately 20% lower among CAREPATH patients (RR1⁄40.79, p1⁄4.055). Using cox proportional hazards models to account for individual differences in time at-risk, the risk of hospitalization was approximately 34% lower (adjusted Hazard Ratio (HR) 1⁄4 0.66, p1⁄4.015) among CAREPATH patients after 30 days, and approximately 29% lower (HR 1⁄4 0.71, p1⁄4.019) after 60 days. Conclusions: Patients receiving CAREPATH depression care were significantly less likely to experience acute care hospitalization during 30-day and 60-day Medicare home health episodes. Results suggest that depression care management may be an important element of routine home health and post-acute care practices, not only to treat depression but to reduce risk of adverse outcomes and associated medical costs.