Higher Rates Of Rehospitalization Research Articles

Results of a Feasibility Pilot Pragmatic Trial Implementing Palliative Care in Skilled Nursing Facilities.

Background: Seriously ill older adults are admitted for post-acute care in skilled nursing facilities (SNFs) for curative, rehabilitative treatments, yet experience high rates of re-hospitalization, and death. The primary palliative care in post-acute care (PPC-PAC) intervention is an evidence-based approach designed to help people with serious illness align treatment plans with goals of care, optimize quality of life, and improve satisfaction with their care. Objectives: To conduct a preliminary study and evaluate the feasibility of implementing the PPC-PAC intervention in the post-acute care SNF setting. Design: Two-group, multisite feasibility pilot pragmatic clinical trial with a non-equivalent design. Measurements: Primary outcome measures-eligibility, enrollment, and data collection rates; consultation satisfaction; and fidelity. Effectiveness outcome measure-quality of life using the Palliative Outcomes Scale version 2. Results: Close to 70% of those who were eligible and approached by the study team (45/65) enrolled in the trial throughout 12 SNFs in the Northeast and Mid-Atlantic United States. Thirty-five were enrolled from intervention sites; 10 were enrolled from control sites (usual care). Most participants (80%) expressed general satisfaction with PPC-PAC, and 90% of clinicians implemented the PPC-PAC intervention as intended. At 21 days follow-up, there were no significant differences in effectiveness outcomes. Conclusion: Implementation of the PPC-PAC intervention proved to be feasible and acceptable among older adults and clinicians. Future research should focus on testing the effectiveness of PPC-PAC and explore strategies for optimal intervention implementation and SNF staff engagement in the post-acute care setting.

Electroconvulsive therapy (ECT) and Psychiatric rehospitalization rates: a retrospective study

BackgroundElectroconvulsive therapy (ECT) induces a generalized seizure under anesthesia with an electrical current for treatment-resistant patients and may be underutilized. To our knowledge, no large-scale, American, nationwide hospital system retrospective study has examined how ECT affects psychiatric rehospitalization chances.MethodsWe analyzed initial inpatient encounters for adults aged > 18 years at HCA Healthcare Behavioral Health Units from 2016 to 2021 with diagnoses of major depressive disorder with/without psychosis, bipolar disorder with/without psychosis, schizoaffective disorder, and schizophrenia. Excluding pregnancy and incarceration cases, we compared psychiatric rehospitalization rates within 365 days for patients receiving ECT versus those with the same diagnoses not receiving ECT. Subgroup analyses were conducted by diagnosis, length of stay, sex, and race. Detailed statistical analyses included bivariate analyses with Fisher’s Exact Test and Wilcoxon Rank Sum Test.ResultsWe analyzed 38,109 distinct patients, 637 of which received ECT. The rehospitalization rate was 37.52% for ECT recipients versus 20.71% for non-ECT patients (p < 0.0001). ECT was associated with higher rehospitalization rates, particularly for severe diagnoses like psychosis (87.28%), schizoaffective disorder (3.77%), and schizophrenia (6.59%). ECT patients had significantly longer rehospitalization lengths of stay (mean 14.53 days vs. 6.54 days for non-ECT, p < 0.0001). White patients received ECT more frequently. Females received ECT more often, while males had higher rehospitalization rates.ConclusionsECT was associated with higher psychiatric rehospitalization rates and longer lengths of stay. This suggests ECT is more commonly used for complex, severe cases which may contribute to higher rehospitalization. Stronger social support and hospital and geographic ties among ECT patients may also play a role.

Technological Developments, Exercise Training Programs, and Clinical Outcomes in Cardiac Telerehabilitation in the Last Ten Years: A Systematic Review.

Cardiovascular diseases (CVDs) are associated with very high rates of re-hospitalization and mortality worldwide, so the complexity of these pathologies requires frequent access to hospital facilities. The guidelines also emphasize the importance of cardiac rehabilitation (CR) programs, which have demonstrated a favorable effect on outcomes, and cardiac telerehabilitation (CTR) could represent an innovative healthcare delivery model. The aim of our review is to study how technologies used in rehabilitation have changed over time and also to understand what types of rehabilitation programs have been used in telerehabilitation. We searched randomized controlled trials (RCTs) in three electronic databases, PubMed, Web of Science, and Scopus, from January 2015 to January 2024, using relevant keywords. Initially, 502 articles were found, and 79 duplicates were identified and eliminated with EndNote. In total, 16 RCTs fulfilled the pre-defined criteria, which were analyzed in our systematic review. The results showed that after CTR, there was a significant improvement in main outcome measures, as well as in relation to technological advances. Moreover, compared to center-based rehabilitation, CTR can offer further advantages, with better cost-effectiveness, the breakdown of geographical barriers, and the improvement of access to treatment for the female population, which is traditionally more socially committed.

Effects of Nicotinamide Adenine Dinucleotide on Older Patients with Heart Failure.

Heart failure (HF) is the main cause of death in middle-aged and older people and is characterized by high morbidity, high mortality, a high rehospitalization rate, and many high-risk groups. Nicotinamide adenine dinucleotide (NAD+) is widely present in the mitochondria of cardiomyocytes and maintains the redox balance in the body, which can effectively treat HF. We sought to evaluate whether NAD+ therapy has some clinical efficacy in patients with HF. Based on using conventional drugs to treat HF, patients (n = 60) were randomized 1:1 to saline and 50 mg NAD+ with 50 mL of normal saline for 7 days. The baseline characteristics of patients before and after treatment and cardiac function (N-terminal pro B-type natriuretic peptide (NT-proBNP) level and left ventricular ejection fraction (LVEF) value) were analyzed. Serological analysis (sirtuin-1 (SIRT1), sirtuin-3 (SIRT3), sirtuin-6 (SIRT6), reactive oxygen species (ROS), and endothelin) was also performed. Among the 60 patients with HF who were treated with NAD+ for 7 days, the improvement rate in NT-proBNP levels and LVEF values was better than in the saline group, although not statistically significant. These patients were more likely to benefit from NAD+ because of higher levels of anti-oxidative stress (SIRT1, SIRT3, SIRT6, and ROS) and anti-endothelial injury (endothelin) than those in the saline control group. According to the results of this study, it is believed that 7 days of NAD+ injections has a positive effect on improving cardiac function, oxidative stress, and endothelial injury in patients with HF compared with the saline control. Chinese Clinical Trial Registry (http://www.chictr.org.cn/) ChiCTR2300074326; retrospectively registered on 3 August 2023.

Recurrence of left ventricular systolic dysfunction and its risk factors in heart failure with improved ejection fraction patients receiving guideline-directed medical therapy: A trajectory analysis based on echocardiography

BackgroundDespite the better prognosis of heart failure (HF) with improved ejection fraction (HFimpEF), remnant cardiovascular risks, including cardiovascular death, rehospitalization, and future deterioration of left ventricular (LV) systolic function, remain in HFimpEF. However, for HFimpEF patients, especially for those receiving guideline-directed medical therapy (GDMT), the recurrent LV systolic dysfunction and its risk factors is still unclear. MethodsA total of 1098 HF patients under HF follow-up management system were initially screened. Echocardiography was re-evaluated at 3-, 6-, and 12-month follow-up. After exclusion, a total of 203 HFimpEF patients on GDMT were enrolled in our final analysis. Cox regression analysis was conducted to select risk factors. ResultsDuring the 1-year follow-up, a total of 28 (13.8%) patients had recurrent LV systolic dysfunction. The trajectory analysis of echocardiographic parameters illustrated that persistent decline of left ventricular ejection fraction (LVEF) and worsening LV remodeling was observed in patients with recurrent LV systolic dysfunction. Multivariable Cox regression analysis identified that ischemic cardiomyopathy, atrial fibrillation, higher left ventricular end-diastolic diameter index (LVEDDI), elevated serum potassium, and a lack of sodium-glucose co-transporter-2 inhibitors (SGLT2i) treatment were confirmed as independent risk factors for recurrent LV systolic dysfunction. Recurrent LV systolic dysfunction was associated with higher rehospitalization rate. ConclusionIn our longitudinal cohort study, almost 14% HFimpEF receiving GDMT suffered recurrent LV systolic dysfunction. Ischemic cardiomyopathy, atrial fibrillation, higher LVEDDI, higher serum potassium, and a lack of SGLT2i therapy were tightly associated with recurrence of LV systolic dysfunction. Relapse of LV systolic dysfunction correlated with poor prognosis.

Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients

IntroductionWe investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC). Materials and MethodsAn exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression. ResultsOf 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively). ConclusionWe observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations. Level of EvidenceLevel IV; Prognosis Study.

Characteristics and outcome of hospitalized patients with heart failure stratified for chronic kidney disease.

Heart failure (HF) and chronic kidney disease (CKD) place significant challenges on the healthcare system, and their co-existence is associated with shared adverse outcomes. The multinational CaReMe project was initiated to provide contemporary, real-world epidemiological data on cardiovascular and reno-metabolic diseases. Utilizing data from the German CaReMe cohort, we characterize a multicentric HF population and describe in-hospital outcomes stratified for co-morbid CKD. This retrospective, observational study analysed administrative data from inpatient cases hospitalized in 87 German Helios hospitals between 1 January 2016 and 31 August 2022. The first hospitalization of patients aged ≥18years with a primary discharge diagnosis of HF, based on ICD-10 codes, were considered the index cases, and subsequent hospitalizations were considered as readmissions. Baseline characteristics and outcomes were stratified for co-morbid CKD using ICD-10-encoding from the index cases. Cox regression was utilized for readmission endpoints and in-hospital mortality. In total, 174829 index cases (mean age 79±15years, 49.9% female) were included; of these, 55.0% had coexisting CKD. Patients with CKD were older, suffered from worse HF-related symptoms, had a higher co-morbidity burden, and in-hospital mortality was increased at index and during follow-up. Prevalent CKD was associated with higher rehospitalization rates and was an independent predictor for in-hospital death. Within this HF inpatient cohort from a multicentric German database, CKD was diagnosed in more than half of the patients and was associated with increased in-hospital mortality at baseline and during follow-up. Rehospitalizations were observed earlier and more frequently in patients with HF and co-morbid CKD.

Shifting the Paradigm: How Stress Hyperglycemia Alters the Landscape of Heart Failure Management.

Background Acute decompensated heart failure (ADHF) significantly contributes to global morbidity. Stress hyperglycemia (SHGL), although commonly observed in non-diabetic ADHF patients, remains underexplored. This study investigates the predictive value of SHGL for major adverse cardiac events (MACEs) and its impact on coronary intervention outcomes. Methods In this prospective observational study at a tertiary care center, 650 non-diabetic ADHF patients admitted for coronary intervention between April 2021 and April 2022 were assessed. SHGL was defined by random blood sugar levels >140 mg/dl. We monitored the incidence of MACEs, including cardiac death, non-fatal myocardial infarction, and heart failure rehospitalization, alongside the success rates of coronary revascularizations over 12 months. Results SHGL was present in 54% of patients (n=352) and was significantly associated with increased MACEs (p<0.001), higher rehospitalization rates (p<0.01), and lower success in revascularization (p<0.05). Using logistic regression, SHGL, age >65, and prior heart failure hospitalization were identified as independent predictors of MACEs. Statistical analyses were performed using two-tailed Mann-Whitney U tests, with significance levels set at p<0.05 for noteworthy findings and p<0.01 or p<0.001 for highly significant findings. Conclusions SHGL significantly impacts coronary intervention outcomes and the future prognosis of heart failure in non-diabetic ADHF patients, identifying it as a critical, modifiable risk factor. These findings advocate integrating SHGL management into ADHF care, emphasizing the need for further research to develop standardized treatment protocols. Proper management of SHGL could potentially improve patient outcomes, highlighting the importance of metabolic control in heart failure management.

The Effectiveness of Discharge Planning Implementation on the Quality of Life of Post Opname Patients with Heart Failure at Hospital

Background: Heart failure is a disease with a high rehospitalization rate due to patients not fulfilling recommended therapy, for example, breaking a diet, doing excessive physical activity and lack of understanding during discharge planning. This causes a decrease in the quality of life after patient is discharged. Purpose: This research aims to determine the effectiveness of discharge planning implemention on the quality of life of post-opname patients with heart failure at Bhayangkara Hospital, Kediri City. Method: The type of research used is quantitative research with a descriptive cross-sectional study design. The number of samples in this study were 31 respondents with accidental sampling technique. Results: The results of the non-parametric Spearman rank correlation test analysis obtained a value of p = 0.022 (p &lt;0.05) and a correlation coefficient of 0.411 which is moderate and has a positive direction. This shows that there is a positive relationship between the effectiveness of implementing Discharge Planning on the quality of life of post-hospitalized patients with heart failure at Bhayangkara Hospital, Kediri City. Conclusion: Discharge Planning given to patients with heart failure at Bhayangkara Hospital, Kediri City is not yet effective and needs to be improved. However, the majority of respondents have a good quality of life where respondents experience an increase in socialization, psychology, but still experience physical discomfort.

Rehospitalization following Discharge from Newborn Nursery during Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic.

This study aimed to compare rehospitalization rates, diagnoses, and well-baby nursery (WBN) length of stay (LOS) among rehospitalized infants born during the COVID-19 pandemic to those born prior. A retrospective comparison of 215 infants rehospitalized from March 1, 2019, to March 1, 2021, was performed in an urban academic center. Rates of readmission were determined for all infants using an unadjusted odds ratio. Among infants rehospitalized at ≤30 and ≤7 days, key cohort characteristics were analyzed using chi-square analysis, Fisher's exact test, independent t-test, and nonparametric testing as applicable. Differences in readmission diagnoses determined by International Classification of Diseases (ICD) code and chart review were evaluated with multivariable logistic regression comparing infants born during the pandemic to the year prior. Pandemic infants had a 51% increased odds of rehospitalization ≤7 days of discharge from WBN compared with prepandemic infants (95% confidence interval [CI]: 1.09-2.09). Rehospitalized infants born during the pandemic had shorter WBN LOS; infants rehospitalized ≤30 days had LOS of 54.3 ± 18.6 versus 59.6 ± 16.2 hours (p = 0.02) and infants rehospitalized ≤7 days had LOS of 53.8 ± 17.8 versus 60.8 ±17.0 hours (p = 0.02). The pandemic group of infants had a 3.5 increased odds of being readmitted for hyperbilirubinemia compared with other diagnoses after adjusting for biological sex, ethnicity, percent weight lost at time of discharge, gestational age, and mode of delivery (CI 1.9, 6.4). Rehospitalization ≤7 days post-WBN discharge was more common in infants born during the pandemic. Infants rehospitalized during the pandemic were more likely to have shorter WBN LOS and to be rehospitalized for hyperbilirubinemia. Retrospective analyses limit conclusions about causation but suggest that being born during the pandemic increased risk of rehospitalization for hyperbilirubinemia among infants in urban, under resourced setting warranting further investigation. · Newborns rehospitalized during the pandemic had a shorter newborn nursery stay.. · Newborns in the pandemic had a higher rate of rehospitalization within 7 days of birth compared to year prior.. · More infants who required readmission during the pandemic were hospitalized for hyperbilirubinemia..

Clinical Review of Hypertensive Acute Heart Failure.

Although acute heart failure (AHF) is a common disease associated with significant symptoms, morbidity and mortality, the diagnosis, risk stratification and treatment of patients with hypertensive acute heart failure (H-AHF) still remain a challenge in modern medicine. Despite great progress in diagnostic and therapeutic modalities, this disease is still accompanied by a high rate of both in-hospital (from 3.8% to 11%) and one-year (from 20% to 36%) mortality. Considering the high rate of rehospitalization (22% to 30% in the first three months), the treatment of this disease represents a major financial blow to the health system of each country. This disease is characterized by heterogeneity in precipitating factors, clinical presentation, therapeutic modalities and prognosis. Since heart decompensation usually occurs quickly (within a few hours) in patients with H-AHF, establishing a rapid diagnosis is of vital importance. In addition to establishing the diagnosis of heart failure itself, it is necessary to see the underlying cause that led to it, especially if it is de novo heart failure. Given that hypertension is a precipitating factor of AHF and in up to 11% of AHF patients, strict control of arterial blood pressure is necessary until target values are reached in order to prevent the occurrence of H-AHF, which is still accompanied by a high rate of both early and long-term mortality.

Histotripsy-induced bactericidal activity correlates to size of cavitation cloud in vitro.

Large abscesses are walled-off collections of pus and bacteria that often do not respond to antibiotic therapy. Standard of care involves percutaneous placement of indwelling catheter(s) for drainage, a long and uncomfortable process with high rehospitalization rates. The long-term goal of this work is to develop therapeutic ultrasound approaches to eradicate bacteria within abscesses as a noninvasive therapeutic alternative. Inertial cavitation induced by short pulses of focused ultrasound (histotripsy) is known to generate lethal mechanical damage in bacteria. Prior studies with Escherichia coli (E. coli) in suspension demonstrated that bactericidal effects increase with increasing peak negative amplitude, treatment time and duty cycle. The current study investigated correlates of bactericidal activity with histotripsy cavitation cloud size. Histotripsy was applied to E. coli suspensions in 10-mL sample vials at 810 kHz, 1.2 MHz, or 3.25 MHz for 40 minutes. The cavitation activity in the sample vials was separately observed with high-speed photography. The cavitation cloud area was quantified from those images. A linear relationship was observed between bacterial inactivation and cavitation cloud size (R2 = 0.96), regardless of the acoustic parameters (specifically frequency, pulse duration and power) used to produce the cloud.

Ten year evolution of clinical characteristics and short-term outcome of patients admitted with heart failure

Abstract Background/Introduction Heart failure (HF) continues to be a leading cause of morbidity, decreased quality of life (QoL) and mortality worldwide. Contributing to decreased QoL is the high rehospitalization rate, which is often related to non-cardiac causes, highlighting the important multimorbidity of the HF population. Detailed clinical and outcome data for HF admissions in Belgium over time are only scarcely available. Purpose We aimed to evaluate and compare two groups of patients admitted with HF ten years apart, regarding clinical characteristics, comorbidities, use of HF medication and devices, as well as rehospitalization rate and all-cause mortality three months post-discharge. Methods This is a monocentric retrospective observational cohort study conducted in Belgium. Two groups of patients admitted for acute decompensated HF who were discharged alive were included and compared: 340 patients during 2011-2012 and 319 patients during 2021-2022. Results The two cohorts did not differ significantly regarding age (77.3 vs. 78.4 years), gender (47.4 vs. 44.5% women), number of patients with HF with reduced ejection fraction (47.4 vs. 48.6%) and NT-proBNP on admission (8514 vs. 7398 pg/mL). Similarly, comorbidities including diabetes, chronic obstructive pulmonary disease, peripheral artery disease, stroke and renal failure were comparable in both groups. Concerning medical therapy at discharge, mineralocorticoid receptor antagonists (MRA) were used significantly more frequently in the latest cohort. However, there was no change in administration of beta-blockers or renin angiotensin aldosterone system antagonists. As part of the implementation of new therapies for heart failure with reduced ejection fraction, 29% of patients were prescribed sodium-glucose cotransporter-2 (SGLT-2) inhibitors, while sacubitril/valsartan was given in 13% of the cases. The use of internal defibrillators (ICD) and resynchronization devices (CRT) doubled from 2011-2012 to 2021-2022 (3.9 vs. 9.6%, p = 0.002). In-hospital length of stay decreased significantly over a ten-year period across all ejection fraction subgroups from 7 to 5 days (figure 1). The combined outcome of rehospitalization for HF and all-cause mortality three months post-discharge remained constant at approximately 20% (figure 2). Conclusion Clinical characteristics and comorbidities of patients admitted with acute decompensated HF did not change significantly between 2011 and 2022. Uptake of evidence-based medicine for HF increased, especially for MRA, SGLT-2 inhibitors and sacubitril/valsartan, as did the use of ICD and CRT, but still with considerable potential for improvement. Although in-hospital length of stay decreased significantly over time, rehospitalization rates for HF and all-cause mortality within 90 days post-discharge remained high and did not improve. These sobering results illustrate the need for continuing efforts to improve the care and outcome of HF patients.

Clinical characteristics of patients with cardiac sarcoidosis who were hospitalized for heart failure

Abstract Background Cardiac sarcoidosis (CS) often leads cardiac dysfunction and exacerbates heart failure. However, there are limited data regarding CS patients who were hospitalized for acute heart failure (AHF). Purpose We aimed to compare the patient characteristics and outcomes between patients with CS who were hospitalized for AHF (CS-AHF) and patients with AHF of other etiology. Methods A total of 4,556 hospitalized patients with CS were identified from the Japanese Diagnosis Procedure Combination database from 2012 to 2020. Among them, we analyzed 254 patients who were hospitalized due to AHF. Patient characteristics, prior medical history, medical therapy for heart failure, intensive care management during hospitalization, in-hospital outcomes and rehospitalization within one year after the index hospitalization were compared with general 4,056 hospitalized AHF patients who were enrolled in the Kyoto Congestive Heart Failure registry. Results Patients with CS-AHF were younger (71 [63-78] vs 80 [72-86]) and more women (69% vs 45%; p &amp;lt; 0.001) than general AHF patients. In addition, CS-AHF were associated with lower prevalence of hypertension, diabetes and dyslipidemia (46% vs 72%, p &amp;lt; 0.001; 28% vs 37%, p = 0.005; and 21% vs 38%, p &amp;lt; 0.001), and lower prescription of angiotensin converting enzyme inhibitors or angiotensin II receptor blocker (28 % vs 46%; p &amp;lt; 0.001) while prescription of beta-blockers were similar between the groups. The length of hospital stay was significantly longer in CS-AHF (23 [14-39] days vs 16 [11-25] days), more patients were treated by intensive respiratory care (32% vs 25%; p = 0.05) and cardiac resynchronization therapy defibrillator (CRTD) implantation (6% vs. 0.5%; p &amp;lt; 0.001) Although in-hospital mortality was similar between the groups, the rate of rehospitalization within one year was higher in CS-AHF (51% vs 39%; p = 0.001). Conclusions Patients with CS-AHF were younger, more women and had lower cardiovascular risk factors than those with AHF in general. CS-AHF were associated with longer hospital stay, higher rate of CRTD implantation and higher rehospitalization rates. More attention might be needed for this distinct group of patients.

The Importance of Optimal Hydration in Patients with Heart Failure-Not Always Too Much Fluid.

Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.

Experiences of in-hospital care among dementia caregivers in the context of high neighborhood-level disadvantage.

Persons living with dementia (PLWD) experience high rates of hospitalization and rehospitalization, exposing them to added risk for adverse outcomes including delirium, hastened cognitive decline, and death. Hospitalizations can also increase family caregiver strain. Despite disparities in care quality surrounding hospitalizations for PLWD, and evidence suggesting that exposure to neighborhood-level disadvantage increases these inequities, experiences with hospitalization among PLWD and family caregivers exposed to greater levels of neighborhood disadvantage are poorly understood. This study examined family caregiver perspectives and experiences of hospitalizations among PLWD in the context of high neighborhood-level disadvantage. We analyzed data from the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) study, an in-depth, multisite qualitative study examining hospitalization and rehospitalization of PLWD in the context of high neighborhood disadvantage, to identify caregiver perspectives and experiences of in-hospital care. Data were analyzed using rapid identification of themes; duplicate transcript review was used to enhance rigor. Data from N = 54 individuals (47 individual interviews, 2 focus groups with 7 individuals) were analyzed. Sixty-three percent of participants identified as Black/African American, 35% as non-Hispanic White, and 2% declined to report. Caregivers' experiences were largely characterized by PLWD receiving suboptimal care that caregivers viewed as influenced by system pressures and inadequate workforce competencies, leading to communication breakdowns and strain. Caregivers described poor collaboration between clinicians and caregivers with regard to in-hospital care delivery, including transitional care. Caregivers also highlighted the lack of person-focused care and the exclusion of the PLWD from care. Caregiver perspectives highlight opportunities for improving hospital care for PLWD in the context of neighborhood disadvantage and recognition of broader issues in care structure that limit their capacity to be actively involved in care. Further work should examine and develop strategies to improve caregiver integration during hospitalizations across diverse contexts.

Monitoring Water Balance to Predict Hospitalization in Patients with Chronic Heart Failure: A Retrospective Study

Background: Patients with chronic heart failure often experience repeated acute exacerbations leading to high rates of rehospitalization. Therefore, the management of patients to prevent rehospitalization and retain their physical function is important. Brain natriuretic peptide (BNP) and N-terminal-pro BNP are used to estimate the conditions of patients with chronic heart failure, but some hospitals cannot measure these levels in real time. To overcome this, we used bioelectrical impedance analysis as an alternative. Methods and results: Between April 2017 and December 2019, we measured water balance in the outpatient department of Hirose Hospital in three groups: those who had been hospitalized for chronic heart failure (257 patients), those with chronic heart failure who had not been hospitalized (224 patients), and controls with other chronic diseases (275 patients). We found that water balance was significantly correlated to the history of hospitalization, and age was a confounding bias in this correlation, regardless of whether patients have been hospitalized with chronic heart failure. Moreover, patients who have high extracellular water content/total body water content ratios, even in a stable period, are at risk of becoming unstable and experiencing rehospitalization. Conclusion: Water balance monitoring could be a useful indicator to estimate patient condition in real time and predict improvement in chronic heart failure. This easy-to-use indicator may enable timely management of exacerbation of patient condition and reduce hospitalization events.

3-Year Outcome in Patients With Combined Precapillary and Postcapillary Pulmonary Hypertension: Results From PADN-5 Trial

BackgroundLong-term benefits of pulmonary artery denervation (PADN) for patients with combined precapillary and postcapillary pulmonary hypertension (CpcPH) secondary to left heart failure are unknown. ObjectivesThe authors sought to report the 3-year clinical results of PADN for patients with CpcPH. MethodsA total of 98 patients with CpcPH, defined as having mean pulmonary arterial pressure of ≥25 mm Hg, pulmonary capillary wedge pressure of >15 mm Hg, and pulmonary vascular resistance of >3.0 WU, were randomly assigned to receive the sham + sildenafil or PADN. The primary endpoint was the occurrence of clinical worsening defined as cardiopulmonary death, rehospitalization or heart/lung transplantation at 3-year follow-up. Changes in the 6-minute walk distance and N-terminal pro–B-type natriuretic peptide served as secondary points. ResultsAt the 3-year follow-up, clinical worsening was reported in 49 (50.0%) patients, with 31 (62.0%) in the sham + sildenafil group and 18 (37.5%) in the PADN group (HR: 2.13 [95% CI: 1.19-3.81]; P = 0.011), largely driven by a higher rate of rehospitalization in the sham + sildenafil group (56.2% vs 35.4%; HR: 1.96 [95% CI: 1.07-3.58]; P = 0.029) by Cox proportional hazards regression. At the end of the study, cardiopulmonary-related deaths occurred in 16 (32.0%) patients in the sham and 9 (18.8%) (P = 0.167) patients in the PADN group. PADN also resulted in a more profound increase in the 6-minute walk distance and reduction in N-terminal pro–B-type natriuretic peptide. ConclusionsPADN is associated with significant improvements in exercise capacity, cardiac function, and clinical outcomes. Further study without approved drugs for pulmonary arterial hypertension is required to confirm the benefits of PADN for patients with CpcPH. (Pulmonary Arterial Denervation in Patients With Pulmonary Hypertension Associated With the Left Heart Failure [PADN-5]; NCT02220335)

The Effect of Knowledge of the Elderly and Family Caregivers on the Incidence of Readmission in the Elderly with Heart Failure: Systematic Review

Heart Failure (HF) is a progressive disease that occurs in 0.13% of Indonesia's population and is dominated by the elderly. This disease requires high costs due to high rehospitalization rates. In meeting their daily needs, the elderly with HF needs caregivers to pay attention to their health, prevent risk factors, and identify resources owned by the family to support the needs of the elderly with HF. The aim of this systematic review was to identify the effect of knowledge of elderly clients and caregivers on the incidence of re-hospitalization in the elderly with HF. The data collection method uses an electronic database from journals that have been published through ScienceDirect, EBSCOHost, ProQuest, ClinicalKey, and Scopus. The data was analyzed using PRISMA diagram. The results of the systematic review of related journals show that the knowledge of clients and caregivers can reduce the incidence of re-hospitalization, and worsening of conditions, and reduce the risk of mortality in heart failure patients, therefore good understanding and literacy is needed for caregivers and elderly clients with HF.

#5505 EFFICACY OF PAXLOVID WITHIN 5 DAYS VERSUS 5 DAYS AFTER DIAGNOSIS IN COVID-19 PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims With the liberalization of COVID-19 control policies in mainland China, the majority of the Chinese population has experienced Omicron infection since mid-December 2022. Paxlovid is a commonly used antiviral drug for patients with COVID-19, but there are few studies in patients with chronic kidney disease (CKD).Therefore, we conducted a retrospective cohort study to explore the drug efficacy of Paxlovid in patients with CKD at different time points after COVID-19 infection. Method 70 CKD patients who were admitted to the Department of Nephrology, the Third Affiliated Hospital of Southern Medical University before January 07, 2023 and diagnosed with COVID-19 were included.The patients were divided into three groups: No Paxlovid group, Paxlovid group within 5 days of diagnosis, Paxlovid group after 5 days of diagnosis, each patient was followed-up for at least 4 weeks. The primary outcome measures included all-cause mortality, length of hospital stay, PCR positive duration and the aggravation of the disease requires ICU admission or mechanical ventilation, or the initiation of renal replacement therapy, and re-hospitalization. The t test or non-parametric test was used to compare the quantitative data, the chi-square test was used to compare the rates, and the K-M curve and Cox regression model were used for survival analysis. Results Among the 70 patients (mean age 65.8±15.90 years, male sex 67.7%), Paxlovid was not used in 35 patients (50%), used in 16 patients (22.9%) within 5 days of diagnosis, and in 19 patients (27.1%) after 5 days. At the start of follow-up, there were no significant differences in age, gender, eGFR, comorbidities, COVID-19 severity and laboratory parameters between patients who used Paxlovid within 5 days and after 5 days of diagnosis. However, patients who used Paxlovid had more severe disease than those who did not use Paxlovid (P&amp;lt;0.001), and patients were more likely to use glucocorticoids (74.3% vs 17.1%, P&amp;lt; 0.001), as well as lower lymphocyte count (0.54*10^9/L vs 0.85*10^9/L, P = 0.016) and percentage (9.5% vs 14.2%, P = 0.009), Higher levels of IL-6 (68.57 pg/ml vs 14.66 pg/ml, P = 0.015) and CRP(113.36 mg/L vs 24.57 mg/L, P = 0.001). After a median follow-up of 45 days, we found that patients used Paxlovid had significantly longer hospital stays and higher rehospitalization rates, with subgroup analysis finding that the increased length of stay and rehospitalization rates were mainly attributable to Paxlovid use after 5 days of diagnosis. Patients who used Paxlovid after 5 days had longer nucleic acid positive time (25 days vs 7 days, P = 0.001) and longer hospital stay (16 days vs 10 days, P = 0.008) compared with those who used Paxlovid earlier. At the end of follow-up, a total of nine patients had died. The K-M survival curve was drawn after the exclusion of mild patients, which showed that patients who used Paxlovid within 5 days had the lowest risk of death, those who did not use Paxlovid had the highest risk of death, and those who used Paxlovid after 5 days fell in between. However, due to the small sample size, the difference was not statistically significant (P = 0.155). The Cox regression analysis showed that IL-6 (HR 1.009; 95% CI: 1.004-1.014, P = 0.001)was the best predictor of death risk in COVID-19 patients with CKD after adjusting other factors. Conclusion The risk of death in CKD patients infected with COVID-19 is significantly higher than that in the general population. Early use of Paxlovid to inhibit virus replication has a good therapeutic effect on these patients, which can greatly reduce the risk of death, admission to ICU or emergency renal replacement therapy. Delayed use of Paxlovid may increase the time of nucleic acid positive and the length of hospital stay.