Hospital Readmissions In Heart Failure Patients Research Articles

Gender differences in the impact of frailty on 90-day hospital readmission in heart failure patients: a retrospective cohort study.

Frequent hospital readmissions after heart failure (HF) are common, however, there is limited data on the association between frailty status and hospital readmission in HF patients. This study aimed to examine the 90-day hospital readmission rates and gender differences in the impact of frailty on 90-day hospital readmission in HF patients. We retrospectively analysed hospital discharge records of 279 patients (men = 169, women = 110) who were diagnosed with HF between January 2017 and December 2018. Frailty was assessed using the Korean version of the FRAIL scale. A logistic regression analysis was conducted to explore the factors predicting 90-day hospital readmission by gender. The prevalence of frailty and 90-day hospital readmissions were ∼54.4% and 22.7% in women, compared with 45.6% and 27.8% in men, respectively. Frail patients with HF have an increased risk of 90-day hospital readmission in both males and females. Particularly, women with frailty had a higher risk of 90-day hospital readmission [adjusted odds ratio (OR) 6.72, 95% confidence interval (CI) 1.41-32.09] than men with frailty (adjusted OR 4.40, 95% CI 1.73-11.17). Our findings highlight that readmission within 90 days of hospitalization for HF can be predicted by patients' frailty. More importantly, we found that women with frailty have a greater risk of readmission than men with frailty. Screening for frailty should therefore be integrated into the assessment of HF patients. Tailored interventions for preventing adverse outcomes should consider gender-associated factors in HF patients with frailty.

Association Between Use of EHR-Generated Dashboards and Hospital Outcomes in 30-Day Heart Failure Readmissions.

This study examined whether usage of clinical data from the electronic health record (EHR) to create organizational- and unit-level performance dashboards and assess adherence to clinical practice guidelines is associated with hospital outcomes in risk-adjusted 30-day readmissions for patients with a principal diagnosis of heart failure (HF). It further assesses the association between the metrics of hospital financial health and the usage of those EHR-generated tools.A cross-sectional study design was used. The study used data from the 2016 American Hospital Association Annual Survey Information Technology Supplement, the Pennsylvania Health Care Cost Containment Council's (PHC4's) 2017 Hospital Performance Report, and the PHC4 General Acute Care Hospitals Financial Analysis Report for fiscal year 2017. Contingency tables, likelihood-ratio chi-square tests, and logistic regression were applied for data analysis.Usage of the EHR to assess adherence to clinical practice guidelines and create EHR-generated unit-level performance dashboards, rather than organizational performance dashboards, was more strongly associated with the hospitals' rating in risk-adjusted 30-day readmissions for HF patients. An increase in hospitals' operating margin was associated with greater odds of the usage of the discussed EHR tools, after controlling for hospital control/ownership and the total number of beds.Usage of some EHR-generated analytical tools may be more strongly associated with lower-than-expected 30-day hospital readmissions in HF patients than with other tools. Better hospital financial health is linked with greater uptake of the discussed analytical tools. Further research could help to determine which EHR-generated tools are more effective in improving hospital outcomes in HF.

Symptom Clusters and Their Impacts on Hospital Readmission in Patients With Heart Failure: A Cross-Sectional Study.

Readmissions after hospitalization due to multiple symptoms in heart failure (HF) are common and costly. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. Therefore, early identification of symptom clusters could improve symptom recognition and reduce hospital readmission. However, little is known about the relationship between symptom clusters and readmission in HF patients. This study aimed to identify symptom clusters among Korean patients with HF and the relationship between symptom clusters and hospital readmission. This cross-sectional study included 306 HF outpatients within 12 months after discharge. Exploratory factor analysis was used to identify the symptom clusters. Multiple logistic regression analysis was used to examine the effect of symptom clusters on readmission, after adjusting for sociodemographic and clinical characteristics. Three symptom clusters were identified in HF patients: the "respiratory distress" cluster, "bodily pain and energy insufficiency" cluster, and "circulatory and gastrointestinal distress" cluster. Patients with class III or IV of HF functional class experienced three symptom clusters at a higher level. This study showed that the "bodily pain and energy insufficiency" cluster was the strongest predictor of hospital readmission in HF patients (adjusted odds ratio = 6.59, 95% confidence interval (CI) [1.29, 32.79]). A higher level of "bodily pain and energy insufficiency" cluster was associated with hospital readmission in Korean HF patients. Health-care providers should be encouraged to consider patients' cultural backgrounds to recognize differences in symptom clusters. Further studies are needed to evaluate symptom clusters across international cohorts and their impacts on patients' outcomes.

Optimizing Management of Heart Failure by Using Echo and Natriuretic Peptides in the Outpatient Unit.

Chronic heart failure (HF) is an important public health problem and is associated with high morbidity, high mortality, and considerable healthcare costs. More than 90% of hospitalizations due to worsening HF result from elevations of left ventricular (LV) filling pressures and fluid overload, which are often accompanied by the increased synthesis and secretion of natriuretic peptides (NPs). Furthermore, persistently abnormal LV filling pressures and a rise in NP circulating levels are well known indicators of poor prognosis. Frequent office visits with the resulting evaluation and management are most often needed. The growing pressure from hospital readmissions in HF patients is shifting the focus of interest from traditionally symptom-guided care to a more specific patient-centered follow-up care based on clinical findings, BNP and echo. Recent studies supported the value of serial NP measurements and Doppler echocardiographic biomarkers of elevated LV filling pressures as tools to scrutinize patients with impending clinically overt HF. Therefore, combination of echo and pulsed-wave blood-flow and tissue Doppler with NPs appears valuable in guiding ambulatory HF management, since they are potentially useful to distinguish stable patients from those at high risk of decompensation.

Effectiveness of Motivational Interviewing in Decreasing Hospital Readmission in Adults With Heart Failure and Multimorbidity.

Hospitalizations are common in heart failure (HF). Multimorbidity, defined as ≥2 comorbid conditions, drives many readmissions. The purpose of this pilot study was to test the effectiveness of motivational interviewing (MI) in decreasing these hospital readmissions. We enrolled 100 hospitalized HF patients into a randomized controlled trial, randomizing in a 2:1 ratio: intervention (n = 70) and control (n = 30). The intervention group received MI tailored to reports of self-care during one home visit and three to four follow-up phone calls. After 3 months, 34 participants had at least one hospital readmission. The proportion of patients readmitted for a condition unrelated to HF was lower in the intervention (7.1%) compared with the control group (30%, p = .003). Significant predictors of a non-HF readmission were intervention group, age, diabetes, and hemoglobin. Together, these variables explained 35% of the variance in multimorbidity readmissions. These preliminary results are promising in suggesting that MI may be an effective method of decreasing multimorbidity hospital readmissions in HF patients.

Noncompliance predicts multiple hospital readmissions in heart failure patients

Noncompliance Predicts Multiple Hospital Admissions in Heart Failure Patients Lorraine S Evangelista, Lynn V Doering, Kathleen A Dracup, Mary A Woo, UCLA Sch of Nursing, Los Angeles, CA Multiple hospital admissions for heart failure (HF) are progressively increasing and may be related to noncompliance. METHODS: To study this relationship, a retrospective chart audit of all patients discharged with HF at a large VA facility in 1997 -1998 was conducted. Using a multivariate logistic regression model, patients who required more than 1 HF admission within 1 year were compared to those who did not on indicators of compliance (alcohol use, current smoking), demographic variables (age, race, marital status), disease variables (New York Heart Association [NYHA] Class, HF etiology), and support variables (living with significant other, type of medical provider). RESULTS: Of 753 patients admitted wjth HF during the review period (mean age 69.1 %, 99% male), 220 patients (29.2%) were readmitted to the hospital at least once (range 1-8 readmissions, mean = 1. 79:t .27) after the index admission. In a muttivariate analysis, independent predictors of readmissions included living alone (odds ratio [OR] 2.09; 95% confidence interval [Cl], 1.42-3.09), HF associated with ischemic etiology (OR. 3.99; 95% Cl, 2.58-6.1 8), NYHA (OR, 2.57; 95% Cl, 1.86-3.55), noncompliance (current smoking [OR, 1.82; 95% Cl, 1.1 7-2.82} and current alcohol use [OR, 5.92; 95% Cl, 3.83-9.13]), and medical provider other than a cardiologist (OR, 2.41 ; 95% Cl, 1.57-3.67). CONCLUSION: This study confirms that noncompliance to smoking and alcohol restrictions, which may be readily amenable to change, dramatically increase the risk of hospital readmissions in HF patients. Consequently, evaluation of noncompliance to smoking and alcohol consumption in HF patients may be a key component for the reduction' of hospital readmissions. Thus interventions which improve compliance to smoking and alcohol restrictions could have significant impact on HF patient outcomes.