Risk Of Hospitalization In Patients Research Articles

Temporal Trends in Mortality and Hospitalization Risk in Patients With Heart Failure According to the Hospital Frailty Risk Score.

Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time. We identified 131 235 patients with new-onset HF (median age 74 years, 39.7% women) from Danish nationwide registers in 1999 to 2017. Stratification according to the Hospital Frailty Risk Score resulted in (1) 102 635 (78%) nonfrail, (2) 26 054 (20%) moderately frail, and (3) 2609 (2%) severely frail patients. The proportion of moderately frail patients increased from 13.2% to 24.9%. Five-year absolute risks of all-cause mortality, HF hospitalization, and non-HF hospitalization were calculated using the Kaplan-Meier and Aalen-Johansen estimators. From 1999 to 2002 to 2003 to 2017, all-cause mortality risk (95% CI) declined from 56.4% (55.8%-57.0%) to 33.3% (32.6%-34.1%), 79.8% (78.5%-81.0%) to 58.6% (57.2%-60.1%), and 90.8% (85.6%-96.0%) to 79.8% (76.4%-83.2%) in nonfrail, moderately frail, and severely frail patients, respectively. HF hospitalization risk remained almost constant over the study period. Non-HF hospitalization risk declined from 74.0% (73.5%-74.5%) to 65.8% (65.0%-66.5%) in nonfrail patients and remained stable overall in moderately frail and severely frail patients over the study period. We observed an increase in frail patients. Mortality decreased for all frailty groups but remained high for severely frail patients. These findings indicate the need for further evidence on the optimization of care for frail patients with HF, and future research should address the development of comprehensive management strategies, integrating frailty assessment into standard clinical care and focused care for older patients with HF.

Temporal trends in mortality and hospitalisation risk in patients with heart failure according to frailty status

Abstract Background Heart failure (HF) and frailty often coexist, and patients with both conditions have a higher risk of mortality and hospitalisation compared with those who are not frail. Over the past two decades, advances in medication targeting HF have been introduced, prolonging the life of patients with HF, but also resulting in increased comorbidity accumulation and susceptibility to frailty. It remains unknown how the interplay between HF and frailty at HF onset impacts patient prognosis and how this has changed over time. Purpose We investigated the temporal trends in the risk of all-cause mortality and HF hospitalisation in patients with HF from 1999 to 2017 according to their frailty status. Methods From Danish nationwide registers, we included patients with new-onset HF. Patients were categorised into four groups according to the year of HF onset: 1999-2002, 2003-2007, 2008-2012, and 2013-2017. The Hospital Frailty Risk Score was used to classify patients into frailty severity categories: 1) non-frail, 2) moderately frail, and 3) severely frail. The primary outcome was the 5-year cumulative incidence of all-cause mortality, assessed using the Kaplan-Meier estimator. The secondary outcome was the 5-year risk of HF hospitalisation, assessed using the Aalen-Johansen estimator, accounting for the competing risk of death. Moreover, a sensitivity analysis was conducted using a multivariable Cox proportional hazard model, investigating the interaction between year group and frailty status for all-cause mortality, comparing frail patients with non-frail patients. Results Among 131,235 patients with HF (median age 74 years; 39.7% female), 102,635 (78%) were categorised as non-frail, 26,054 (20%) as moderately frail, and 2609 (2%) as severely frail. The proportion of moderately frail patients increased the most, from 13% in 1999 to 25% in 2017. From 1999-2002 to 2003-2017, the 5-year cumulative incidence of all-cause mortality declined from 56.4% (95% CI, 55.8-57.0%) to 33.3% (32.6-34.1%), 79.8% (78.5-81.0%) to 58.6% (57.2-60.1%), and 90.8% (85.6-96.0%) to 79.8% (76.4-83.2%) in the non-frail, moderately frail, and severely frail patient group, respectively (Fig 1). The largest relative improvement was observed in the non-frail patient group. The 5-year cumulative incidence of HF hospitalisation remained fairly constant across the frailty groups (Fig 2). Conclusions From 1999 to 2017, we observed an increase in moderately and severely frail patients. Overall, the mortality risk decreased across all frailty groups. These findings underscore the importance of implementing guidelines directed at frail patients with HF.5-year risk of all-cause mortality5-year risk of HF hospitalisation

Impact of real-world remote symptom monitoring program on hospitalizations and ICU admissions.

377 Background: Previous randomized controlled trials have demonstrated benefits to patients from remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) including healthcare utilization. However, less is known about the impact of RSM in diverse, real-world populations. Methods: This cross-sectional analysis from a hybrid, type 2 implementation-effectiveness trial evaluated the impact of RSM on healthcare utilization amongst patients with cancer receiving chemotherapy, immunotherapy, monoclonal antibody, or targeted therapy at two academiccancer centers in the Southeastern United States. Modified Poisson regression models with robust standard error and 95% confidence interval (CI) was used to calculate the relative risk (RR) of any hospital or ICU utilization between patients receiving RSM and controls for 3 and 6 months after index date. Models were controlled for age at index, race, sex, cancer type, cancer stage, insurance, prior treatment, comorbidities, RUCA, and follow-up during COVID-19 pandemic. Additional logistic regression models were used to estimate odds ratios (OR) for subset analysis stratified by race (Black or African American, Other, or White), rurality using Rural-Urban Commuting Area Codes, and neighborhood disadvantage using Area Deprivation Index (ADI). Results: From 5/2021-2/2024, 1215 patients were enrolled in RSM; 27% were Black, 16% lived in a rural area, and 25% lived in an area with high neighborhood disadvantage. The populations receiving RSM were similar to the control population (n = 4559); 26% were Black, 22% lived in a rural area, and 28% lived in area with high neighborhood disadvantage. The unadjusted relative risk of hospitalization for patients receiving RSM and control patients were 0.70 (95% CI, 0.63-0.70) and 0.77 (95% CI, 0.71-0.85), respectively. In adjusted analyses, hospitalizations were lower amongst patients receiving RSM compared to control patients with a RR of 0.82 (95% CI 0.73-0.92). Similar patterns were observed for ICU admissions (RR 0.59; 95% CI,0.40-0.88). Analysis by patient subgroup was similar to the overall analysis. A lower odd of hospitalizations and ICU admissions at 6 months was observed across all subset analyses: Black vs. White patients (OR 0.80; OR 0.48); rural vs. urban patients (OR 0.78; OR 0.68); and patients living in areas of high vs. lower neighborhood disadvantage (OR 0.59; OR 0.33). Conclusions: The use of RSM amongst patients receiving treatment for cancer is associated with reductions in hospitalizations and ICU admissions in real-world, diverse settings. Further work to expand this intervention nationally is needed. Clinical trial information: NCT04809740 .

Temporal Association Between Atrial Fibrillation Burden in Cardiac Implantable Electronic Devices and the Risk of Heart Failure Hospitalization.

Atrial fibrillation (AF) events in cardiac implantable electronic devices (CIEDs) are temporally associated with stroke risk. This study explores temporal differences in AF burden associated with HF hospitalization risk in patients with CIEDs. Patients with HF events from the Optum de-identified Electronic Health Records from 2007 to 2021 and 120 days of preceding CIED-derived rhythm data from a linked manufacturer's data warehouse were included. AF burden ≥5.5 h/d was defined as an AF event. The AF event burden in the case period (days 1-30 immediately before the HF event) was considered temporally associated with the HF event and compared with the AF event burden in a temporally dissociated control period (days 91-120 before the HF event). The odds ratio for temporally associated HF events and the odds ratio associated with poorly rate-controlled AF (>110 bpm) were calculated. In total, 7257 HF events with prerequisite CIED data were included; 957 (13.2%) patients had AF events recorded only in either their case (763 [10.5%]) or control (194 [2.7%]) periods, but not both. The odds ratio for a temporally associated HF event was 3.93 (95% CI, 3.36-4.60). This was greater for an HF event with a longer stay of >3 days (odds ratio, 4.51 [95% CI, 3.57-5.68]). In patients with AF during both the control and case periods, poor AF rate control during the case period also increased HF event risk (1.78 [95% CI, 1.22-2.61]). In all, 222 of 4759 (5%) patients without AF events before their HF event had an AF event in the 10 days following. In a large real-world population of patients with CIED devices, AF burden was associated with HF hospitalization risk in the subsequent 30 days. The risk is increased with AF and an uncontrolled ventricular rate. Our findings support AF monitoring in CIED algorithms to prevent HF admissions.

Paliperidone palmitate 6-month formulation for the treatment of schizophrenia: a 14-month follow-up study

IntroductionRelapse prevention is critical because psychopathology and functionality can worsen in patients with schizophrenia because the repeated episodes and we have strong evidence of antipsychotics efficacy for relapse prevention, but nonadherence rates in patients with schizophrenia are very high, even in comparison with other illness.There is extensive clinical trial evidence for the use of paliperidone palmitate 1-month (PP1M) and paliperidone palmitate 3-month (PP3M) formulations for maintaining treatment continuity and preventing relapses and risk of hospitalizations in patients with schizophrenia. (Najarian et al. Int J Neuropsychopharmacol 2022; 25(3) 238-251). Paliperidone palmitate 6-month (PP6M) formulation is a presentation that provides a dosing interval of once every six months.ObjectivesThe principal aim of this study was to evaluate the effectiveness, safety, and tolerability of the PP6M in patients with non-acute schizophrenia on an outpatient basisMethodsMethods: Sample: 22 patients diagnosed with schizophrenia (DSM 5 criteria) that started treatment with PP6M after being stabilized with PP1M (N:10) or PP3M (N:12) (the treatment dose was not changed in the four months before study inclusion)Bimonthly, the following evaluations were performed during a follow-up period of 14 months:The Clinical Global Impression-Schizophrenia scale (CGI-SCH)Treatment adherence, concomitant medication, adverse events and the number of hospitalizations and emergency visitsEfficacy values: Percentage of patients who remained free of admissions at the end of 14months of follow-up.Other evaluation criteria: Percentage of patients who never visited the emergency department at the end of 14 months of follow-up, average change from baseline visit to the final evaluation as assessed by score obtained on the following scale: GSI-SCH, treatment adherence rate and tolerability.ResultsThe percentage of patients who remained free of admission at the end of the 14 months follow-up was 90% in the total sample, 83% in the PP3M pre-treatment group and 100% in the PP1M pre-treatment group.The percentage of patients who never visited the emergency department at the end of 14 months follow-up was: 81% in the total sample, 75% in the PP3M pre-treatment group and 90% in the PP1M pre-treatment group.At the end of the study, a mean change of +0.12 (±0.11) on the ICG-SCH-SI scale in the total sample, +0.25 (±0.21) in the PP3M pre-treatment group and 0 in the PP1M pre-treatment group.The treatment persistence rate at the 14 month of follow-up was 100% in the total sample.Treatment was well tolerated, and no safety-related adverse events were collected. There were no tolerability-related withdrawals from treatment.ConclusionsIn our study, we found that long-term treatment with paliperidone palmitate 6-month formulation is effective and well tolerated in clinical practice conditions.Disclosure of InterestNone Declared

Antipsychotic Use and Psychiatric Hospitalization in First-Episode Non-affective Psychosis and Cannabis Use Disorder: A Swedish Nationwide Cohort Study.

There is a paucity of research on treatment outcomes of patients with psychosis and cannabis use disorder (CUD). We aimed to compare the effectiveness of antipsychotics in reducing the risk of hospitalization in patients with first-episode psychosis (FEP) and co-occurring CUD. We utilized a nationwide Swedish cohort of patients with longitudinal register data from the year 2006 to 2021. Participants were patients with FEP and co-occurring CUD (n = 1820, 84.73% men, mean age 26.80 years, SD 8.25 years). The main outcome was hospitalization due to psychotic relapse. Hospitalization due to any psychiatric disorder or substance use disorder (SUD) were examined as secondary outcomes. Within-individual Cox regression models were used to study these associations. Use of any antipsychotic was associated with a 33% risk reduction of psychotic relapse (aHR = 0.67; 95% CI 0.60-0.75). Clozapine (0.43; 0.29-0.64), long-acting injectable (LAI) formulations of risperidone (0.40; 0.22-0.71), aripiprazole (0.42; 0.27-0.65), and paliperidone (0.46; 0.30-0.69) were associated with the lowest risk of relapse. The association between the LAI formulation of olanzapine and hospitalization due to psychosis was statistically non-significant (0.61; 0.35-1.05). Clozapine was associated with an 86% risk reduction of hospitalization due to SUD (0.14; 0.05-0.44). Of oral non-clozapine antipsychotics, aripiprazole was associated with the lowest risk of hospitalization due to psychotic relapse (0.61; 0.45-0.83). These findings support the use of clozapine, LAI formulations of second-generation antipsychotics other than olanzapine, or oral aripiprazole to prevent hospitalization in FEP and co-occurring CUD.

Diabetes mellitus does not alter mortality or hospitalisation risk in patients with newly diagnosed heart failure with preserved ejection fraction: Time to rethink pathophysiological models of disease progression.

Type 2 diabetes is a common and adverse prognostic co-morbidity for patients with heart failure with reduced ejection fraction (HFrEF). The effect of diabetes on long-term outcomes for heart failure with preserved ejection fraction (HFpEF) is less established. Prospective cohort study of patients referred to a regional HF clinic with newly diagnosed with HFrEF and HFpEF according to the 2016 European Society of Cardiology guidelines. The association between diabetes, all-cause mortality and hospitalisation was quantified using Kaplan-Meier or Cox regression analysis. Between 1st May 2012 and 1st May 2013, of 960 unselected consecutive patients referred with suspected HF, 464 and 314 patients met the criteria for HFpEF and HFrEF respectively. Within HFpEF and HFrEF groups, patients with diabetes were more frequently male and in both groups patients with diabetes were more likely to be treated with β-adrenoceptor antagonists and angiotensin converting enzyme inhibitors. After adjustment for age, sex, medical therapy and co-morbidities, diabetes was associated with increased mortality in individuals with HFrEF (HR 1.46 95% CI: 1.05-2.02; p = .023), but not in those with HFpEF (HR 1.26 95% CI 0.92-1.72; p = .146). In unselected patients with newly diagnosed HF, diabetes is not an adverse prognostic marker in patients with HFpEF, but is in HFrEF.

Risk factors for severe COVID-19 in patients with rheumatic diseases

The aim – to study risk factors for severe COVID-19 in patients with rheumatic diseases (RD).Patients and methods. The study included medical histories of 464 patients with RD who were admitted at the V.A. Nasonova Research Institute of Rheumatology from September 27, 2021 to April 26, 2023Results. Age over 60 years, hypertension, obesity, lung disease, chronic kidney disease, coronary heart disease, diabetes mellitus, acute cerebrovascular accident or a history of pulmonary tuberculosis increase the risk of hospitalization in patients with RD with COVID-19 by 3–5 times. In addition, with an increase in the number of concomitant diseases, an increase in the risk of hospitalization was noted by 2–6 times. Taking glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, leads to an increase risk of hospitalization by 1.5–4.5 times, while patients taking hydroxychloroquine or tumor necrosis factor α inhibitors was more often required outpatient treatment.Conclusions. It has been established that older age, the presence of comorbid pathology and the use of glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, are risk factors for severe COVID-19.

Association between self-reported falling risk and risk of hospitalization for patients with chronic obstructive pulmonary disease

RationaleThe association between self-report falling risk in persons with COPD and hospitalization has not been previously explored. ObjectiveTo examine whether self-reported risk is associated with hospitalizations in patients with COPD. MethodsA secondary analysis from a prospective observational cohort study of veterans with COPD. Participants completed questions from the Stopping Elderly Accidents, Deaths and Injuries (STEADI) tool kit at either baseline or at the end of the 12-month study. A prospective or cross-sectional analysis examined the association between responses to the STEADI questions and risk of all-cause or COPD hospitalizations. ResultsParticipants (N = 388) had a mean age of 69.6 ± 7.5 years, predominately male (96 %), and 144 (37.1 %) reported having fallen in the last year. More than half reported feeling unsteady with walking (52.6 %) or needing to use their arms to stand up from a chair (61.1 %). A third were concerned about falling (33.3 %). Three questions were associated with all-cause (not COPD) hospitalization in both unadjusted and adjusted cross-sectional analysis (N = 213): “fallen in the past year” (IRR 1.77, 95 % CI 1.10 to 2.86); “unsteady when walking” (IRR 1.88, 95 % CI 1.14 to 3.10); “advised to use a cane or walker” (IRR 1.89, 95 % CI 1.16 to 3.08). ConclusionsThe prevalence of self-reported falling risk was high in this sample of veterans with COPD. The association between falling risk and all-cause hospitalization suggests that non-COPD hospitalizations can negatively impact intrinsic risk factors for falling. Further research is needed to clarify the effects of all-cause hospitalization on falling risk in persons with COPD.

Risk of hospitalization in synucleinopathies and impact of psychosis.

Few studies have investigated the risk of hospitalization among patients with synucleinopathies (Parkinson disease, Dementia with Lewy Bodies, Parkinson disease dementia, Multiple System Atrophy) with associated psychosis and the impact of antipsychotic treatments on hospital admissions and duration of the stay. To determine the risk of hospitalization among patients with synucleinopathies and in patients with associated psychosis. To evaluate the impact of antipsychotic treatments on hospital admission of patients with synucleinopathies and psychosis in an incident cohort study in Olmsted County, Minnesota (MN). We used the Rochester Epidemiology Project (REP) to define an incident cohort of patients with clinically diagnosed synucleinopathies (1991-2010) in Olmsted County, MN. A movement disorder specialist reviewed all medical records to confirm the clinical diagnosis of synucleinopathies using the NINDS/NIMH unified diagnostic criteria. We included 416 incident cases of clinically diagnosed synucleinopathies from 2,669 hospitalizations. 409 patients (98.3%) were admitted to the hospital at least once for any cause after the onset of parkinsonism. The median number of hospitalizations for a single patient was 5. In total, 195 (46.9%) patients met the criteria for psychosis: patients with psychosis had a 49% (HR = 1.49, p < 0.01) increased risk of hospitalization compared to patients without psychosis. Among patients with psychosis, 76 (39%) received antipsychotic medication. Treatment with antipsychotic medications did not affect the risk of hospitalization (HR = 0.93, p = 0.65). The median length of hospitalization among the entire cohort was 1 (IQR 0-4) day. There was no difference between hospitalization length for patients with no psychosis and patients with active psychosis (RR = 1.08, p = 0.43) or patients with resolved psychosis (RR = 0.79, p = 0.24). Psychosis increases the risk of hospitalization in patients with clinically defined synucleinopathies; however, it does not affect the length of hospital stays in our cohort. Antipsychotic treatment does not affect the risk of hospitalization in our study.

Obesity, Cardiorenal Comorbidities, and Risk of Hospitalization in Patients With Heart Failure With Preserved Ejection Fraction

ObjectiveTo compare clinical features of patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) with those of patients with similar body mass index (BMI) but no HF and to examine the association between degree of obesity and risk for hospitalizations. MethodsThis was a retrospective analysis of 22,750 adults from a large US electronic health care data set (January 1, 2012, through July 31, 2019), including 4975 with HFpEF. Baseline characteristics were compared between patients with HFpEF and a control group matched on BMI, age, sex, and year of BMI record. Risk of first hospitalization was analyzed in the HFpEF sample with negative binomial and Cox proportional hazards models, adjusted for baseline comorbidities. ResultsCompared with controls without HF matched on BMI, age, sex, and year of BMI record, patients with HFpEF displayed worse kidney function, greater estimated plasma volume, and more cardiovascular comorbidities. Within the HFpEF cohort, patients with higher degree of obesity were younger and had fewer concomitant cardiovascular comorbidities than those with lower degree of obesity. The mean number of HF-related hospitalizations increased with higher degree of obesity (9.6 to 15.7/100 patient-years; P=.002), but higher degree of obesity was not associated with increased risk of non–HF-related hospitalizations. ConclusionAmong persons with obesity, increasing cardiorenal dysfunction and volume overload differentiate those with HFpEF. Among persons with established HFpEF, those with higher degree of obesity are younger and have fewer cardiovascular comorbidities but display a unique increased risk of HF-related hospitalizations, even as risk for other hospitalizations is not different.

Short-term outcomes after sodium-glucose cotransporter-2 inhibitor initiation in a cohort of heart failure patients.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) decrease mortality and risk of hospitalization in patients with heart failure with reduced ejection fraction (HFrEF). SGLT2i have a natriuretic effect shortly after initiation, followed by a lasting osmotic diuretic effect. We sought to evaluate rates of acute kidney injury (AKI) and therapy discontinuation with SGLT2i initiation in a real-world cohort of HFrEF patients. We abstracted data on 200 patients with HFrEF initiated on a SGLT2i in the outpatient setting at the University of Michigan (between 1 July 2016 and 2 July 2022). Our co-primary endpoints were rate of AKI and discontinuation of SGLT2i. A total of 200 patients were included. The majority of patients were male (64%) with a mean left ventricular ejection fraction (LVEF) of 27%. One hundred and four (52%) patients had diabetes mellitus. Most patients exhibited New York Heart Association class II (51.5%) or III (33.5%) symptoms. The majority of patients (54%) were taking an angiotensin-receptor neprilysin inhibitor. The mean daily furosemide equivalent diuretic dose was 93.3mg. AKI occurred in 22 patients and 18 patients discontinued their SGLT2i. Yeast infection (n=6), hypotension (n=5), and AKI (n=4) were the most common reasons for discontinuation. Using receiver operating characteristic curve analysis, the strongest models for AKI were A1C [area underneath its curve (AUC)=75.8, empirical confidence interval (ECI) 66.5-83.5]; baseline serum creatinine (SCr) (AUC=72.0, ECI 65.7-78.7); LVEF (AUC=67.6, ECI 58.4-75.8); and furosemide equivalent diuretic dose (AUC=66.0, ECI 57.5-74.6). Similarly, the strongest positive models for SGLT2i discontinuation were A1C (AUC=81.1, ECI 74.8-87.2); baseline SCr (AUC=67.4, ECI 58.7-75.5); LVEF (AUC=68.7, ECI 58.9-76.5); and furosemide equivalent diuretic dose (AUC=67.2, ECI 58.2-76.0). A1C was the strongest model of AKI, and SGLT2i discontinuation in HFrEF patients started on SGLT2i. Glucosuria may be related to this effect. Patients with higher baseline SCr on higher doses of loop diuretics may be at greater risk of these outcomes. Future prospective studies will be needed to further evaluate these findings and other models of AKI and SGLT2i discontinuation to guide clinical use of SGLT2 inhibitors.

Association of the use of psychotropic drugs with hospitalization, cardiovascular events, and mortality in patients with type 2 diabetes: a propensity score-matched cohort study.

Use of psychotropic drugs (PD) may be associated with impairment of physical function. However, few studies have assessed the impact of PD on health outcomes in patients with type 2 diabetes. This study aimed to examine the associations between psychotropic drug use and handgrip strength (HGS) and between the use of PD and hospitalization in patients with type 2 diabetes. From April 2013 to December 2015, we conducted a retrospective cohort study in patients with type 2 diabetes at the National Center for Global Health and Medicine Kohnodai Hospital. Patients aged 20 years and over who can measure HGS were included. All participants received nutritional guidance regarding diet therapy for type 2 diabetes at baseline. Nonpsychotropic drug users were matched one-to-one with the PD users using propensity score matching method with respect to their baseline covariates. The differences in HGS and the number of patients who had hospitalizations during the study period were examined. By Cox proportional hazard regression analysis, the association between the use of PD and repeated hospitalizations was estimated. A total of 1,282 patients were enrolled and followed up for 2.36 ± 0.73 years. In the propensity score matching cohort, HGS was significantly lower (p = 0.006) in PD users than non-PD users. PD users had more hospitalizations than non-PD users. Cox proportional hazard regression analysis confirmed the association of repeated hospitalizations with the use of PD (hazard ratio = 2.138; 95% confidence interval, 1.144-3.995, p = 0.017)). In addition, HGS was significantly and inversely correlated with the number of hospitalizations (r = -0.143, p = 0.013). The use of PD could increase the risk of repeated hospitalizations. Skeletal muscle may play a role in reducing the risk of hospitalization in patients who are treated with PD.

166-OR: Developing a Fair Individualized Polysocial Risk Score (iPsRS) for Identifying Increased Social Risk of Hospitalizations in Patients with Type 2 Diabetes (T2D)

T2D is a public health crisis that must be managed by addressing patients’ unmet social needs. We aimed to develop an electronic health record (EHR)-based individualized polysocial risk score (iPsRS) of T2D, which can be used for identifying patients of high social risk and their unmet social needs. We identified T2D patients using 2015-2020 EHR data from University of Florida Health system and followed a year to record hospitalizations. We (1) used natural language processing to extract person-level social determinants of health (SDoH, e.g., employment, housing and food) from clinical notes; and (2) spatiotemporally linked 117 contextual-level SDoH (e.g., neighborhood walkability). We incorporated both contextual and person-level SDoH and used machine learning(ML) to develop an iPsRS that predicted 1-year hospitalization. We assessed iPsRS’ fairness across racial-ethnic groups (Black or Hispanic vs White) and explored different approaches to mitigate identified bias. Of 10192 T2D patients, mean age was 59±21years, and 16% were hospitalized in a year. Our iPsRS showed a good utility for predicting individuals’ risk of hospitalization (C statistic=0.70). After adjusting for clinical characteristics, iPsRS explained 41% of the increased 1-yr hospitalization risk. The naïve iPsRS was biased on Hispanic vs. White patients, that is, Hispanics (false negative rates [FNR]=0.87) were more likely to be misclassified as having low hospitalization risk compared to their White counterparts (FNR=0.77). We identified that a disparate impact remover approach reduced the bias without compromising much prediction utility, producing a final iPsRS with an optimized prediction (C-statistic=0.69) - fairness (FNR-Hispanic=0.62, FNR-White=0.64) balance. We developed a fair iPsRS that can identify T2D patients at a high risk of hospitalization due to SDoH, supporting the integration of social care with clinical care of T2D. Disclosure Y.Huang: None. T.Zhang: None. W.T.Donahoo: None. E.Shenkman: None. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health. J.Bian: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)

1320-P: Causal Mediators of Underlying Socioeconomic Status Disparities in Hospitalization Risk among Patients with Type 2 Diabetes (T2D)

Socioeconomically disadvantaged groups carry a disproportionally increased risk of T2D-related adverse outcomes, yet few studies have addressed how modifiable social risk factors drive such health disparities. We aimed to estimate to what extent housing instability explained unemployment or education disparities in hospitalization risk in patients with T2D. We used electronic health records data from the University of Florida Health System and identified patients with T2D in 2015-2020. We conducted causal mediation analyses using marginal structural models to test the causal mediator role of housing insecurity in the association between education or employment and hospitalization risk. Of 9,144 eligible patients, mean (SD) age was 58 (13) years, and 17% were hospitalized in the follow-up year. We observed an increased hospitalization risk in those who were unemployed (odds ratio [OR]: 1.21, 95% CI: 1.04-1.41) and those with lower education levels (1.38 [1.17-1.62]). Housing insecurity, as a causal mediator, explained 11% of the unemployment-hospitalization association, but it had minimal contribution to the education-hospitalization association (2%). Unemployment status and lower education were associated with an increased risk of hospitalization in T2D. Housing insecurity modestly contributed to unemployment disparities in hospitalization risk in T2D. Disclosure W.Chen: None. Y.Huang: None. W.T.Donahoo: None. J.Bian: None. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)

Dapagliflozin reduces the risk for hospitalization in patients with type 2 diabetes

Dapagliflozin reduces the risk for hospitalization in patients with type 2 diabetes

Atrial fibrillation - environmental and socio-economic determinants at regional level. Case of Poland

Abstract Funding Acknowledgements Type of funding sources: None. The study aimed to assess the influence of environmental and socioeconomic factors on the prevalence of hospitalization for atrial fibrillation (AF). The rate of AF hospitalizations in Poland is one of the highest in Europe. The risk of hospitalization in patients with AF is related not only to lifestyle, but also to environmental, economic, social factors and the organization of the health care system. Using National Institute of Public Health, Central Statistical Office and Voivodeship Inspectorates for Environmental Protection in Poland data and panel data techniques (including spatial ones) the impact of environmental and socioeconomic factors on AF in Poland has been estimated. The age- and sex-standardized data on the prevalence of hospitalization due to AF in Poland in 2012-2019 on poviats level were explained using set of air quality indicators (namely PM2.5), environmental factors, organization of the health care system and regional determinants of the socioeconomic situation. An increase in the number of physicians by 1/1000 of the population and healthcare expenditure by PLN 100 per capita resulted in a decrease of 2% (-0.002 [-0.003;-0.001]; P=0.002) and 5%(-0.005 [-0.008;-0.002]; P&amp;lt;0.001) in the number of hospitalisations due to AF in the group under 64 years. A 1 pp increase in the proportion of green areas resulted in a 4% decrease in hospitalisations. In contrast, an increase in GDP per capita by 1 th PLN and a decrease in the proportion of people working in agriculture by 1 pp were associated with a 1%( -0.010; [-0.013;-0.007]; P&amp;lt;0.001) and 0.2% decrease in hospitalisations, respectively. There is geographical variation in the prevalence of AF and socioeconomic factors are an important determinant of this condition. In the working-age group, improvements in the economic situation are likely to have positive health effects, in contrast to those in the post-working age group, where increases in health sector expenditure have the greatest effect.

The association of dietary approach to stop hypertension (DASH) diet with hospitalization risk in patients with COVID-19

Given the importance of dietary habits in the immune system, the current study aimed at investigating the association between Dietary Approach to Stop Hypertension (DASH) diet and risk of hospitalization due to COVID-19. Dietary data of 141 patients with COVID-19 were collected using 147-item food frequency questionnaire. DASH score in this cross-sectional study was calculated based on eight components, including fruits, vegetables, legumes and nuts and seeds, whole grains, low-fat dairy, red or processed meats, sweetened beverages, and sodium. Multivariable logistic regression models were applied to estimate the OR and 95% CI for hospitalization due to COVID-19 in each tertile of DASH score. Mean ± SD of DASH score in inpatients (n=74) and outpatients (n= 87) was 22.5 ± 4.57 and 25.34 ± 4.23, respectively. The risk of hospitalization in the highest tertile of DASH score was 81% lower than the lowest tertile (OR=0.19, 95%CI: 0.07-0.55, P trend = 0.001 after adjustment for age, sex, BMI, energy intake). Also, more intake of fruits, vegetables and low-fat dairy products and less intake of sodium, red and processed meat were each significantly associated with reduced risk of hospitalization due to COVID-19. Our data provide evidence that adherence to DASH-style diet was associated with lower risk of hospitalization due to COVID-19.

Positive and Negative Syndrome Scale (PANSS) predictors of hospitalization during home treatment on 1045 patients with schizophrenia in acute crisis

IntroductionSeveral factors related to the risk of requiring psychiatric hospitalization have been described in patients diagnosed with schizophrenia treated with methods other than home treatment. With regard to the symptoms, high global illness severity and positive symptoms of schizophrenia have been most frequently related to the risk of hospitalization in patients with schizophrenia. However, there are no studies describing which clinical factors increase the likelihood of being hospitalized while undergoing home follow-up.ObjectivesTo determine which of the clinical factors assessed in the PANSS predict the risk of hospitalization in patients diagnosed with schizophrenia following a home treatment program.MethodsAll patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. A comparative, bivariate analysis of each item of the PANSS and of the global results of each category was conducted on those who were hospitalized and those who were not hospitalized. Finally, a logistic regression of each category of the PANSS was done on both groups, controlling for other socio-demographic and clinical factors.ResultsA total of 1045 patients with schizophrenia were evaluated in this study. PANSS positive symptom subscale (PANSS-S), PANSS General Psychopathology, PANSS Excited Component and PANSS Global Score scored higher in patients who were finally hospitalized in a conventional acute treatment unit. Regarding the PANSS negative symptom subscale, no significant differences were found between the two groups.In patients who required hospitalization, the scores of all the PANSS positive symptom subscale (PANSS-P) items and all items on the PANSS excited component (excitement, tension, hostility, uncooperativeness and poor impulse control) were significantly higher. Some items regarding general psychopathology (Somatic concern, anxiety, guilt feelings, tension, and mannerisms) were also significantly higher in the hospitalization group. Only 3 items—blunted affect, guilt feelings and motor retardation—scored significantly higher in patients who did not require hospitalization. In the logistic regression, only the global score of the PANSS-P reached statistical significance (P = 0.001).ConclusionsPositive symptoms scored in the PANSS seem to be the most predictive factors of hospitalization regarding clinical symptoms in patients with Schizophrenia following home treatment. Other items regarding exciting symptoms and general psychopathology also showed as relevant regarding the risk of conventional hospitalization in those patients.Disclosure of InterestNone Declared

P253 Histological Remission and Activity as Predictor of Relapse, Hospitalization, and Surgery in Ulcerative Colitis: Systematic Review and Meta-analysis

Abstract Background Treatment targets in patients with inflammatory bowel disease (IBD) have evolved over the last two decades. The significance of histological remission as a treatment target in patients with ulcerative colitis (UC) is not well established. The aim of this study is to assess risk of clinical relapse, hospitalizations and need for surgery in patients who achieved histological remission compared to patients with active histology in UC. Methods MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from inception to October 2022. Inclusion criteria included any randomized controlled trial or observational study that included adult patients with UC who achieved histological remission. The primary outcome was the risk of clinical relapse, hospitalization and need for surgery in patients with UC who achieved histological remission compared to patients with active histology. The outcomes were collected and stratified by 2 time points, 6-12 months and 13 or more months. Random effects model was used to calculate pooled risk ratio (RR) and 95% CIs and I2 statistics were used to assess heterogeneity. Results In total 28 studies were included in this meta-analysis. At 6-12 months, the risk of clinical relapse was higher in patients with active histology compared to patients who achieved histological remission (RR= 2.41, 95% confidence interval (CI) 1.69-3.44, p&amp;lt;0.01). There was no difference in risk of hospitalization in patients with histological remission compared to patients with active histology (RR= 4.22, 95% CI 0.91- 19.62, p=0.07). At 13 months or more, the risk of clinical relapse was higher in patients with active histology compared to patients who achieved histological remission (RR= 2.07, 95% CI 1.55-2.76, p&amp;lt;0.01). Risk of hospitalization and need for surgery was also higher in patients with active histology compared to patients who achieved histological remission; (RR= 2.52, 95% CI 1.59-4.00, p&amp;lt;0.01) and (RR= 3.14, 95% CI 1.53-6.45, p&amp;lt;0.01) respectively. Conclusion Histological remission in ulcerative colitis represents a treatment target that is not yet routinely sought in practice. Our study suggests that patients who achieve histological remission have better outcomes in UC than those with active histology.