Incidence Of Rehospitalization Research Articles

The relationship between neutrophil to lymphocyte ratio (NLR) with rehospitalisation and mortality in patients with acute coronary syndrome (ACS).

To determine the relationship of neutrophil-to-lymphocyte ratio with re-hospitalisation rate and death in acute coronary syndrome patients. The retrospective, observational, analytical study was conducted at Surabaya Hospital, East Java, Indonesia, and comprised data of acute coronary syndrome patients from January to December 2021. Neutrophilto- lymphocyte ratio values taken during each admission were noted, and divided into 3 groups; <3, 3-5 moderate, and >5 high. Data was also noted for the frequency of rehospitalisation and mortality from the institutional medical records. Data was analysed using SPSS 23. Of the 102 patients, 83(81.4%) were males and 19(18.6%) were females. The overall mean age was 56.78±11.53 years. There were 48(47%) patients with low neutrophil-to-lymphocyte ratio, and 27(26.5%) each in the moderate and high categories. There was a strong relationship between neutrophil-to-lymphocyte ratio and mortality (p=0.038). The relationship between neutrophil-to-lymphocyte ratio and rehospitalisation was not significant (p=0.264). The neutrophil-to-lymphocyte ratio was associated with mortality during treatment, but was not associated with the incidence of rehospitalisation in acute coronary syndrome patients.

The Role of Urine Na+ Levels as A Predictor of Diuresis Response, Length of Stay, Rehospitalization And Death Due to Cardiovascular Disease In 30 Days Post Treatment in Acute Heart Failure Patients

Background: The incidence of rehospitalization and death due to cardiovascular disease in acute heart failure (AHF) is relatively high. The spot urine Na+ value 6 and 48 hours after loop diuretic still does not have a clear role as a predictor of diuresis response, length of stay, rehospitalization as well as the composite of rehospitalization events and death due to cardiovascular disease within 30 days. Objective: To determine whether spot urinary Na+ 6 hours and 48 hours after loop diuretic is a predictor of diuresis response, length of stay, rehospitalization as well as a composite of events within 30 days. Methods: This study is a prospective cohort of AHF patients treated in February-March 2024. The independent variable is the spot urine Na+ value 6 and 48 hours after loop diuretic. Outcomes consist of diuresis response, length of stay, rehospitalization as well as a composite of rehospitalization and death due to cardiovascular disease within 30 days. Results: A total of 72 AHF patients were included in the study. Rehospitalization events occurred in 20.8% of cases while composite events occurred in 22.2%. The cut point value for spot urinary Na+ 6 hours after loop diuretic in this study was 62.3 mmol/L. 6-hour spot urine Na+ was a predictor of poor diuresis response with adjusted OR 3.67 (95% CI 1.12-11.8; p &lt; 0.03). Regression analysis showed that 6-hour spot urine Na+ was not a predictor of length of stay (β coefficient: -0,023 95% CI -0,054 – 0,008; p = 0.138). 6-hour spot urine Na+ was a predictor of rehospitalization with adjusted HR 3.53 (95% CI 1.11-11.18; p = 0.032). The 6-hour spot urine Na+ value was a composite predictor of 30-day events with HR 4.89 (95% CI 1.58-15.11; p = 0.006). No association was found between 48-hour spot urine Na+ values with diuresis response, length of stay, rehospitalization and events within 30 days. Conclusion: Spot urine Na+ value 6 hours after loop diuretic is a predictor of diuresis response, rehospitalization and composite events within 30 days. The 6-hour urine Na+ spot value is not a predictor of length of stay. The 48-hour urine Na+ spot value is not a predictor of diuresis response, length of stay, rehospitalization or composite events within 30 days.

The Relationship Between Family Support And Rehospitality in Heart Failure Patients in Kemuning Room, Jombang Hospital

Congestive heart failure is a clinical problem that occurs in patients who have abnormalities, either hereditary or acquired in the structure and function of the heart, causing the development of a series of clinical symptoms of weakness and tightness as well as clinical signs of edema and crackles which result in hospitalization, poor quality of life, and shortened life expectancy. This study aims to determine the relationship between family support and re-hospitalization incidence in heart failure patients in the Kemuning room at Jombang Hospital. The research design used in this study is cross-sectional analytic. The population in this study were all heart failure patients in the Kemuning Room of the Jombang Hospital, with a total of 37 people. A sample of 33 respondents. The sampling technique used is purposive sampling. The research variable is family support and the dependent variable is the incidence of re-hospitalization in heart failure patients. which were analyzed using chi-square with α = 0.05. The results of this study indicated that the majority (60.6%) of respondents had good family support, numbering 20 people, and the majority (69.7%) of respondents who were re-hospitalized in patients with heart failure were up to six months, totaling 23 people. The analysis results obtained 0.000 &lt;0.005, meaning there is a relationship between family support and the incidence of re-hospitalization in heart failure patients in the Kemuning room at Jombang Hospital. From this research, it is hoped that nurses can maximize the role of the family as one of the support systems in caring for congestive heart failure patients undergoing re-hospitalization.

Association Of Heart Rate At Hospital Discharge And Rehospitalization Of Patients With Heart Failure And Reduced Ejection Fraction.

One of the major causes of cardiovascular morbidity and mortality is heart failure. The study aims to assess the effect of heart rate on the incidence of rehospitalization in patients with heart failure and reduced ejection fraction. It is a cross-sectional, analytical research conducted over six months, from June to December 2022, at the cardiology department of a tertiary care hospital. Patients who satisfied the modified Framingham heart failure criteria at admission and were discharged with an initial diagnosis of heart failure and those readmitted within 6 months or less of their discharge were included in the study. Pregnant women, patients diagnosed with cognitive impairment, and patients who had contraindications for taking any of the beta-blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker /angiotensin receptor -neprilysin inhibitor, Sodium-Glucose co-transport inhibitor, and mineralocorticoid inhibitors were excluded from the study. A total of 77 patients were included in the study. At discharge, approximately 71 patients had a heart rate of less than 70 beats/min and had no readmissions whereas, 6 patients had a heart rate of greater than 70 beats/min with 5 patients requiring readmission in the following 6 months. This relationship was statistically significant with a p-value of 0.000. According to the study, heart rate is a significant factor in the rehospitalization of individuals with heart failure and a low ejection fraction. At discharge, if the heart rate is not optimized then the rate of readmissions is increased.

Rehospitalization Incidence in COVID-19 Reinfection: A Retrospective Cohort Study

Rehospitalization Incidence in COVID-19 Reinfection: A Retrospective Cohort Study

Cardio-Ankle Vascular Index Reflects the Efficacy of Waon Therapy in Heart Failure Patients.

Waon therapy is a form of thermal treatment in a dry sauna developed by Tei. Although Waon therapy is reportedly effective for chronic heart failure (CHF) patients, not all patients respond to the therapy. The reason for this ineffectiveness has not been fully clarified. The cardio-ankle vascular index (CAVI) is an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle, and it is thought to reflect some of the afterload of the left ventricle. We investigated the effects of Waon therapy on CAVI and plasma brain natriuretic peptide (BNP) level to clarify the usefulness of CAVI during Waon therapy.CHF patients (n = 21) treated with Waon therapy (2 weeks of 10 sessions) were divided into two groups: responders with an improved BNP level (n = 11) and nonresponders with no improvement in BNP (n = 10). CAVI was measured using Vasela 1500.A significant decrease in CAVI (median and interquartile range) was observed in the responder group (from 10.3 [9.6, 11.6] to 9.6 [8.6, 10.3], P = 0.021), whereas no change was observed in the nonresponder group (from 9.6 [8.6, 10.5] to 9.5 [9.1, 11.2], P = 0.919). The incidence of rehospitalization or cardiac death due to heart failure was significantly higher in patients in whom Waon therapy was ineffective at 12 months of follow-up (log-rank P = 0.001).The effectiveness of Waon therapy in CHF patients may be reflected by the improvement in CAVI.

Heart failure with mildly reduced ejection fraction: not a mid-range prognosis

Abstract Introduction Heart failure with mildly reduced ejection fraction (HFmrEF) has been recognized in the last heart failure guidelines of the European Society of Cardiology, replacing the concept of “midrange ejection fraction”. There is limited data regarding mortality outcomes of HFmrEF compared to heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Purpose We aimed to evaluate whether HFmrEF has a different prognosis after an acute heart failure (AHF) episode, in a real-world contemporaneous southern European population. Methods We retrospectively studied 1026 patients admitted to our emergency department between November 2016 and December 2017 with discharge diagnosis of AHF. Median follow up was 5 months (IQR 3–11 months). Incidence of rehospitalization, cardiovascular (CV) and all-cause mortality were evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves. Results From all patients, 782 were categorized in HFrEF (34.1%), HFmrEF (19.4%) and HFpEF (46.4%). There was heterogeneity between groups. Compared to HFrEF, HFmrEF patients were older (80 [74–84] vs. 76 [67–82] years, p&amp;lt;0.001), with lower prevalence of males (61.2% vs. 76.4%, p=0.004) and coronary artery disease (CAD) (35.5% vs. 47.6%, p=0.024), but higher rates of valvular heart disease (VHD) (48.0% vs. 29.6%, p&amp;lt;0.001). Compared to HFpEF, HFmrEF subjects had higher prevalence of males (61.2% vs. 40.8%, p&amp;lt;0.001) and CAD (35.5% vs. 13.2%, p&amp;lt;0.001). At admission, patients with HFmrEF and HFrEF had similar serum creatinine e B-type natriuretic peptide values, but higher than the HFpEF group: 1.38±0.7 vs. 1.45±0.7 vs. 1.28±0.8mg/dL, p=0.019 and 701 [385–1191] vs. 1000 [494–1776] vs. 360 [214–717]pg/mL, p&amp;lt;0.001, respectively. HFmrEF patients had higher rates of hospitalization (71.7% vs. 43.8%, p&amp;lt;0.001), follow-up readmissions (27.6% vs. 18.7%, p=0.034), CV (11.8% vs. 5.0%, p=0.025) and all-cause mortality (25.7% vs. 14.9%, p=0.015), compared to HFpEF; no differences comparatively to HFrEF. There was no difference between groups regarding the length of hospitalization (9 [5–15] vs. 8 [5–15] vs. 10 [6–17] days, p=0.302). In multivariate logistic regression model adjusted for age, sex, SBP, CAD, VHD, creatinine, and BNP, HFmrEF increased the risk of CV (OR 2.9, 95% CI 1.2–6.7, p=0.016) and all-cause mortality (OR 2.1, 95% CI 1.2–3.9, p=0.011), but not follow-up readmissions (OR 1.7, 95% CI 0.9–2.9, p=0.059). Kaplan-Meier estimates of CV, and all-cause mortality are shown in Figure 1. Conclusions HFmrEF have a similar prognosis to HFrEF and worse than HFpEF, with more readmissions, CV and all-cause mortality, after an AHF episode. Funding Acknowledgement Type of funding sources: None.

Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation.

BackgroundReducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention.ObjectiveThe aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended.MethodsIn a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression–Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms.ResultsIn phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95% CI −0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P≥.05).ConclusionsThe simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations.

In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil

BackgroundWe evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort.MethodsThis prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan–Meier curves and Cox proportional-hazard models were performed.Findings1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9–32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8–29.2)] died during hospitalization (median time 14 (IQR,9–24) days). Older age [vs<40 years; age=60–69 years-aHR=1.89 (95%CI,1.08–3.32); age=70–79 years-aHR=2.52 (95%CI,1.42–4.45); age≥80-aHR=2.90 (95%CI 1.54–5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30–2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13–1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08–2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3–8.4)] had a rehospitalization or death [rate=323 (95%CI 250–417) per 1000 person-years] in a median time of 52 (range 1–280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15–3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22–4.59)] were independently associated with rehospitalization or death after hospital discharge.InterpretationHigh in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge.FundingFundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.

ARNI in HFrEF-One-Centre Experience in the Era before the 2021 ESC HF Recommendations.

Background: Sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), has demonstrated a survival benefit and reduces heart failure hospitalization in patients with heart failure with reduced left ventricular ejection fraction (HFrEF); however, our experience in this field is limited. This study aimed to summarize a real clinical practice of the use of ARNI in HFrEF patients hospitalized due to HFrEF in the era before the 2021 ESC HF recommendations, as well as assess their clinical outcome with regard to ARNI administration. Methods and Materials: Overall, 613 patients with HFrEF hospitalized in 2018–2020 were enrolled into a retrospective one-centre cross-sectional analysis. The study population was categorized into patients receiving (82/13.4%) and not-receiving (531/82.6%) ARNI. Clinical outcomes defined as rehospitalization, number of rehospitalizations, time to the first rehospitalization and death from any cause were analysed in the 1–2 year follow-up in the ARNI and non-ARNI groups, matched as to age and LVEF. Results: Clinical characteristics revealed the following differences between ARNI and non-ARNI groups: A higher percentage of cardiovascular implantable electronic devices (CIED) (p = 0.014) and defibrillators with cardiac resynchronization therapy (CRT-D) (p = 0.038), higher frequency of atrial fibrillation (p = 0.002) and history of stroke (p = 0.024) were in the ARNI group. The percentage of patients with HFrEF NYHA III/IV presented an increasing trend to be higher in the ARNI (64.1%) as compared to the non-ARNI group (51.5%, p = 0.154). Incidence of rehospitalization, number of rehospitalizations and time to the first rehospitalization were comparable between the groups. There were no differences between the numbers of deaths of any cause in the ARNI (28%) and non-ARNI (28%) groups. The independent negative predictor of death in the whole population of ARNI and non-ARNI groups was the coexistence of coronary artery disease (CAD) (beta= −0.924, HR 0.806, p = 0.011). Conclusions: Our current positive experience in ARNI therapy is limited to extremely severe patients with HFrEF. Regardless of the more advanced HF and HF comorbidities, the patients treated with ARNI presented similar mortality and rehospitalizations as the patients treated by standard therapy.

PROGNOSTIC VALUE OF RESIDUAL SYNTAX SCORE COMBINED WITH ACEF SCORE IN ACUTE CORONARY SYNDROME PATIENT AFTER PERCUTANEUS CORONARY INTERVENTION IN SAIFUL ANWAR HOSPITAL, MALANG

Background : Percutaneous coronary intervention (PCI) is one of the revascularization options in patients with clinical acute coronary syndrome (ACS) who often have multiple and complex vascular lesions. So, the decision to complete revascularization is still a topic that is widely explored to reduce the rate of rehospitalization and reinfarction. This study aims to determine the predictor value of rehospitalization and reinfarction events that can be used in ACS patients undergoing IKP using coronary angiography parameters with residual SYNTAX scores and clinical parameters using ACEF scores. Method : The study was cohort prospective with the inclusion criteria being all ACS patients who underwent PCI in RSUD Dr. Saiful Anwar Malang from January 2017 to July 2021. All patients underwent IKP and underwent coronary angiography evaluation after IKP with a residual SYNTAX score (rSS) and divided into categories into rSS≤8 and rSS&gt;8. All patients underwent laboratory examination of serum creatinine and post-PCI echocardiography, and an ACEF score was obtained (ACEF score = age/left ventricular ejection fraction + 1 [if serum creatinine &gt;2 mg/dl]). Research subjects will be followed up for at least 1 year related to the incidence of post-PCI rehospitalization and reinfarction. Results : From a total sample of 209 patients, it was found that the residual SYNTAX score data had the most significant predictive factor for the occurrence of rehospitalization at 1 year after PCI (OR 6.14 [95% CI, 1.92-1967]). At the value of rSS &gt; 8, (AUC 0.750 [95% CI, 0.682-0.818], p 0.001) has a good predictive value for the occurrence of rehospitalization. However, combining with clinical parameters using the ACEF score provides a better predictive value. This study shows that the combination of rSS&gt;8 and ACEF score&gt;1.2 provides a better predictive value (AUC 0.884 [95%CI, 0.832-0.936) for the incidence of rehospitalization in post-PCI ACS patients. Conclusion : Acute coronary syndrome patients with residual SYNTAX scores &gt; 8 and ACEF scores &gt; 1.2 had a strong predictive value for rehospitalization events 1 year after PCI. The use of the combination of these two scores is expected to be a clinical guide to obtain the degree of completeness of revascularization in ACS patients.

Efficacy and safety of intermittent repeated levosimendan infusions in advanced heart failure patients: the LAICA study.

AimsThe aim of the LAICA study was to evaluate the long‐term effectiveness and safety of intermittent levosimendan infusion in patients with advanced heart failure (AdHF).Methods and resultsThis was a multicentre, randomized, double‐blind, placebo‐controlled clinical trial of intermittent levosimendan 0.1 μg/kg/min as a continuous 24‐h intravenous infusion administered once monthly for 1 year in patients with AdHF. The primary endpoint [incidence of rehospitalization (admission to the emergency department or hospital ward for >12 h) for acute decompensated HF or clinical deterioration of the underlying HF] occurred in 23/70 (33%) of the levosimendan group (Group I) and 12/27 (44%) of the placebo group (Group II) (P = 0.286). The incidence of hospital readmissions for acute decompensated HF (Group I vs. Group II) at 1, 3, 6, and 12 months was 4.2% vs. 18.2% (P = 0.036); 12.8% vs. 33.3% (P = 0.02); 25.7% vs. 40.7% (P = 0.147); 32.8% vs. 44.4% (P = 0.28), respectively. In a secondary pre‐specified time‐to‐event analysis no differences were observed in admission for acute decompensated HF between patients treated with levosimendan compared with placebo (hazard ratio 0.66; 95% CI, 0.32–1.32; P = 0.24). Cumulative incidence for the aggregated endpoint of acute decompensation of HF and/or death at 1 and 3 months were significatively lower in the levosimendan group than in placebo group [5.7% vs. 25.9% (P = 0.004) and 17.1% vs. 48.1% (P = 0.001), respectively], but not at 6 and 12 months [34.2% vs. 59.2% (P = 0.025); 41.4% vs. 66.6% (P = 0.022), respectively]. Survival probability was significantly higher in patients who received levosimendan compared with those who received placebo (log rank: 4.06; P = 0.044). There were no clinically relevant differences in tolerability between levosimendan and placebo and no new safety signals were observed.ConclusionsIn our study, intermittent levosimendan in patients with AdHF produced a statistically non‐significant reduction in the incidence of hospital readmissions for acute decompensated HF, a significantly lower cumulative incidence of acute decompensation of HF and/or death at 1 and 3 month of treatment and a significant improvement in survival during 12 months of treatment.

Impact of thrombus aspiration in frail STEMI patients

BackgroundDespite primary percutaneous coronary intervention (PPCI) is generally considered the best therapy in older frail adults with ST-segment elevation myocardial infarction (STEMI), the incidence of re-hospitalization for cardiovascular diseases remains significant in these patients.AimsWe hypothesized that thrombus aspiration (TA) before PPCI could be a useful treatment for reducing mortality and rehospitalizations in frail patients undergoing PPCI for STEMI.MethodsWe conducted a study comparing PPCI alone vs TA + PPCI in frail STEMI patients. We examined a cohort of consecutive frail patients aged ≥ 65 years with first STEMI treated with PPCI between February 2008 and July 2015 at the Department of Cardiology of the “Cardarelli” Hospital in Naples, Italy.ResultsThe study was completed by 389 patients (PPCI: 195, TA + PPCI: 194). At 1-month follow-up, the rate of death from any cause was 7.0% in patients treated with PPCI alone vs 3.0% in patients treated with TA + PPCI (p 0.036), whereas death from cardiovascular causes was 6.0% in the PPCI group vs 3.0% in the TA + PPCI group (p 0.028). Equally important, the rate of re-hospitalization due to heart failure was 7.5% in the PPCI group vs 4.0% in TA + PPCI group (p 0.025) and the rate of re-hospitalization due to acute coronary syndrome was 10.0% in the PPCI group vs 4.5% in the TA + PPCI group (p 0.016).ConclusionThese results indicate the importance of TA in the treatment of STEMI in a group of high-risk patients such as elderly with frailty.

Long-term outcomes following coronary artery bypass grafting: the role of off-pump strategy

Abstract Background The debate on the advantages and limitations of off-pump (OPCAB) on long-term outcomes has not still arrived to a conclusion. This study was designed to compare the impact of OPCAB vs on-pump coronary artery bypass grafting (CABG) on long-term mortality and major adverse cardiac events (MACEs). Methods The PRIORITY project was designed to evaluate the long-term outcomes of 2 large prospective multicenter cohort studies on CABG conducted between 2002–2004 and 2007–2008. Data on isolated CABG were linked to 2 administrative datasets. Time-to-event methods were employed to analyze outcomes. Results The population consisted of 11021 patients who underwent isolated CABG (27.2% OPCAB) that were divided into development and validation datasets. The median follow-up time was 8 years (interquartile range 7.6–10 years) and was 100% complete. Unadjusted long-term survival was significantly worst for OPCAB, nonetheless the adjustment did not confirm OPCAB as a risk factor for mortality (HR 0.94, 95% CI 0.85–1.03, p=0.19). OPCAB was associated to an increased risk of MACE at 10 years (adjusted HR 1.14, 95% CI 1.06–1.23, p=0.001). Inside the MACEs, OPCAB was significantly related to increased incidence of rehospitalization for percutaneous cardiac intervention (PCI), (adjusted HR 1.33, 95% CI 1.16–1.53, p&amp;lt;0.001), demonstrating to be an independent risk factor for PCI with an hazard that is 33% higher than on-pump CABG. Conclusions OPCAB did not affect long-term mortality but is associated with an increased long-term risk of repeat PCI. These findings may have important implications towards health resources allocation, particularly in a climate of cost containment of healthcare expenditures. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Minister of Health

The Relationship Between Medication Adherence, Rehospitalization and Mortality in Bandung, Indonesia

Medication adherence in patients with heart failure is very important. Previous study, the low level of medication adherence in patients with heart failure can increase the risk of recurrence of the patient, thereby increasing the rehospitalization and mortality. This study was conducted to evaluate existing programs in heart failure clinic. The purpose of this study is to determine the relationship between the incidence of medication adherence with the incidence of rehospitalization and mortality in patients with heart failure. Retrospective cohort study conducted using medical record data from the Heart Failure Clinic in dr Hasan Sadikin Hospital Bandung between October 2018 to July 2020. This study involved 77 people with a diagnosis of CHF and had attended a minimum of 6 months of the heart failure clinic program at Dr Hasan Sadikin Hospital, Bandung. Descriptive statistics were used to describe demographic characteristics such as age, gender, and NYHA class. Chi-square analysis was used to analyze the relationship between medication adherence, the incidence of rehospitalization and mortality. Result, demographic data, there are 55 (71.4%) adults and 22 (28.6%) elderly, male 50 (64.9%) and female 27 (35.1%), NYHA I 32 people (41.6%), NYHA II 26 (33.8%), NYHA III 7 (9.1%), NYHA IV 12 (15.6%). Non-adherence 8 (10,4%), rehospitalizayion 20 (26%), and mortality 18 (23,4%). Based on the chi-square statistical analysis, there was a relationship with the incidence of rehospitalization (p &lt;0.001) and there was a relationship with mortality (p &lt;0.002). This study has research limitations, because the data obtained is only based on medical record data. Medication adherence was associated with rehospitalization and mortality. It is important to develop interventions to improve medication adherence. This study is the most recent study conducted at the Heart Failure Clinic Dr Hasan Sadikin Hospital Bandung, and can be used as an evaluation of the program that has been carried out.

Evaluation of the Application Effect of "Yilian Family Medical Health Service Platform" in the Health Education for Cardiovascular Patients.

Background:To explore the effect of the “Yilian Family Medical Health Service Platform” used by cardiology nurses on the health education of cardiovascular patients.Methods:Overall 380 patients with coronary heart disease were selected from the Second Hospital of Dalian Medical University, Dalian China in 2019. They were divided into control group (190 cases) and observation group (190 cases) according to the method of digital random allocation. The traditional discharge health education model was used in control group, that is, oral education before discharge. On the basis of traditional health education, the “Yilian Family Medical Health Service Platform” was recommended in the observation group. Patients could use the platform to communicate and consult with the family doctor team. The awareness of disease and medication, compliance, incidence of rehospitalization, and satisfaction with nursing work were compared in the two groups after discharge from the hospital.Results:The experimental group was significantly better than the control group in terms of disease awareness, medication adherence, return visits, and rehospitalization (P <0.05).Conclusion:The “Medical Federation Family Medical Health Service Platform” could be used by nurses as a continuation of health education for patients with cardiovascular disease after discharge from the hospital. It can promote patient recovery, improve medication compliance, reduce the rate of rehospitalization, and obviously improve patients’ satisfaction to the nursing staff.

A Systematic Review and Meta-Analysis: Safety and Efficacy of Mesenchymal Stem Cells Therapy for Heart Failure.

Preclinical and clinical evidence suggests that mesenchymal stem cells (MSCs) may be beneficial in treating Heart Failure (HF). However, the effects of stem cell therapy in patients with heart failure is an ongoing debate and the safety and efficacy of MSCs therapy are not well-known. We conducted a systematic review of clinical trials that evaluated the safety and efficacy of MSCs for HF. This study aimed to assess the safety and efficacy of MSCs therapy compared to the placebo in heart failure patients. We searched PubMed, Embase, Cochrane library systematically, with no language restrictions. Randomized Controlled Trials (RCTs) assessing the influence of MSCs treatment function controlled with placebo in heart failure were included in this analysis. We included RCTs with data on safety and efficacy in patients with heart failure after mesenchymal stem cell transplantation. Two investigators independently searched the articles, extracted data, and assessed the quality of the included studies. Pooled data was performed using the fixed-effect model or random-effect model by the use of Review Manager 5.3. The Cochrane risk of bias tool was used to assess the bias of included studies. The primary outcome was safely assessed by death and rehospitalization and the secondary outcome was efficacy, which was assessed by six-minute walk distance and Left Ventricular Ejection Fraction (LVEF), Left Ventricular End-systolic Volume (LVESV), Left Ventricular End-diastolic Volume (LVEDV) and Brain Natriuretic Peptide (BNP). A total of twelve studies were included, involving 823 patients who underwent MSCs or placebo treatment. The overall rate of death showed a trend of reduction of 27% (RR [CI]=0.73 [0.49, 1.09], p=0.12) in the MSCs treatment group. The incidence of rehospitalization was reduced by 47% (RR [CI]=0.53[0.38, 0.75], p=0.0004). The patients in the MSCs treatment group realised an average of 117.01m (MD [95% CI]=117.01m [94.87, 139.14], p<0.00001) improvement in 6MWT. MSCs transplantation significantly improved Left Ventricular Ejection Fraction (LVEF) by 5.66 % (MD [95% CI]=5.66 [4.39, 6.92], p<0.00001), decreased Left Ventricular End-Systolic Volume (LVESV) by 14.75 ml (MD [95% CI]=-14.75 [-16.18, - 12.83], p<0.00001) and Left Ventricular End-Diastolic Volume (LVEDV) by 5.78 ml (MD [95% CI]=- 5.78[-12.00, 0.43], p=0.07), in the MSCs group, BNP was decreased by 133.51 pg/ml MD [95% CI]= - 133.51 [-228.17,-38.85], p=0.54, I2= 0.0%) than did in the placebo group. Our results suggested that mesenchymal stem cells as a regenerative therapeutic approach for heart failure are safe and effective by virtue of their self-renewal potential, vast differentiation capacity and immune modulating properties. Allogenic MSCs have superior therapeutic effects and intracoronary injection is the optimum delivery approach. In the tissue origin, patients who received treatment with umbilical cord MSCs seem more effective than bone marrow MSCs. As to dosage injected, (1-10)*10^8 cells were of better effect.

Comparing Perioperative Complications Between Laparoscopic and Robotic Radical Cystectomy for Bladder Cancer.

Background: Minimally invasive cystectomy is being increasingly performed, however, data comparing laparoscopic radical cystectomy (LRC) and robotic radical cystectomy (RRC) are scarce. We compared 30- and 90-day Clavien-Dindo Classification (CDC) complications between patients undergoing LRC and RRC at our center. Materials and Methods: We retrospectively evaluated 300 patients who underwent minimally invasive radical cystectomy from January 2007 to July 2019 and grouped them into LRC (112 patients) and RRC (188 patients). We compared the two groups for demographic variables, perioperative characteristics, and 30- and 90-day CDC overall, minor, and major complications. Multivariable logistic regression analysis was performed to identify variables that predict perioperative complications. Results: The two groups were comparable for the duration of surgery (270 minutes in LRC vs 265 minutes in RRC) and rate of conversion to open surgery. The RRC cohort had a higher estimated blood loss (EBL) (675 mL vs 500 mL, p = 0.006), but the two groups had a comparable need for intraoperative transfusion. Patients undergoing RRC also had a shorter duration of hospital stay (13 days vs 14 days, p < 0.001). There was no difference between the two groups for 30- and 90-day CDC overall, minor, and major complications. The incidence of rehospitalization within 30 days (p = 0.1) and surgical reintervention (p = 0.5) was also comparable between the two groups. On multivariable logistic regression analysis, approach to cystectomy (RRC vs LRC) was not a significant predictor of 30-day CDC overall and major complications. Conclusion: LRC was associated with lesser EBL, whereas the hospital stay was shorter in patients undergoing RRC. The two approaches were comparable with each other for 30- and 90-day CDC overall, minor, and major complications. The choice between the two approaches should depend on availability and surgeon experience and preference, rather than any specific perioperative parameter.

Effects of Pimobendan on Prolonging Time to Rehospitalization or Frequency of Rehospitalization in Patients with Heart Failure: A Retrospective Cohort Study Using a Medical Administrative Database (PREFER Study).

BackgroundAs approximately 24% of patients with chronic heart failure are rehospitalized within 1 year and heart failure is aggravated by repeated hospitalizations, greater importance was attached to the prevention of hospitalization.ObjectiveThe objective of this study was to investigate the influence of pimobendan on rehospitalization of patients with advanced heart failure using a Japanese medical administrative database.MethodsFrom January 2010 to February 2018, patients hospitalized two or more times for heart failure were selected for analysis. The primary endpoint was the incidence of hospitalizations for heart failure during the follow-up period, which was compared between pimobendan prescription and non-prescription groups after propensity score matching.ResultsThe total number of patients with heart failure included during the study period was 1 421 110 and we matched 276 patients in both groups. The incidence of rehospitalization throughout the period to completion of follow-up was 365.23/1000 people/yr (95% confidence interval [CI]: 327.78–402.69) in the pimobendan prescription group and 537.81/1000 people/yr (95% CI: 492.36–583.27) in the non-prescription group. The cumulative incidence at 365 days was significantly lower in the pimobendan prescription group (pimobendan prescription group: 35.4% (95% CI: 29.8–41.8), non-prescription group: 51.2% (95% CI: 45.1–57.7), (P < 0.001). The adjusted hazard ratio in the pimobendan prescription group was 0.556 (95% CI: 0.426–0.725, P < 0.001).ConclusionPimobendan was suggested to extend the time to rehospitalization for patients with advanced heart failure. It is necessary to verify the results of this study by performing a prospective study. In addition, the influence of pimobendan on general heart failure patients must be examined.

Nurse-Led Collaborative Management Using Telemonitoring Improves Quality of Life and Prevention of Rehospitalization in Patients with Heart Failure.

The effects of disease management using telemonitoring for patients with heart failure (HF) remain controversial. Hence, we embedded care coordination and enhanced collaborative self-management through interactive communication via a telemonitoring system (collaborative management; CM). This study evaluated whether CM improved psychosocial status and prevented rehospitalization in patients with HF in comparison with self-management education (SM), and usual care (UC).We randomly allocated 59 patients into 3 groups; UC (n = 19), SM (n = 20), and CM (n = 20). The UC group received one patient education session, and the SM and CM groups participated in disease management programs for 12 months. The CM group received telemonitoring concurrently. All groups were followed up for another 12 months. Data were collected at baseline and at 6, 12, 18, and 24 months.The primary endpoint was quality of life (QOL). Secondary endpoints included self-efficacy, self-care, and incidence of rehospitalization. The QOL score improved in CM compared to UC at 18 and 24 months (P < 0.05). There were no significant differences among the 3 groups in self-efficacy and self-care. However, compared within each group, only the CM had significant changes in self-efficacy and in self-care (P < 0.01). Rehospitalization rates were high in the UC (11/19; 57.9%) compared with the SM (5/20; 27.8%) and CM groups (4/20; 20.0%). The readmission-free survival rate differed significantly between the CM and UC groups (P = 0.020).We conclude that CM has the potential to improve psychosocial status in patients with HF and prevent rehospitalization due to HF.