One-year Rehospitalization Rates Research Articles

Epidemiology of hospitalized heart failure in France based on national data over 10years, 2012-2022.

We aim to describe the incidence of HF hospitalization in France in the post-pandemic era, the prevalence of HF cases and patients' characteristics, management and outcomes while focusing on sex, age and socio-economic differences and to analyse time-trends between 2012 and 2022. Based on the French health care database providing medical information for almost the whole French population, patients hospitalized for acute decompensated HF without history of HF in the 5years were identified by the International Classification of Diseases - 10th revision (ICD-10) codes. In 2022, the estimated prevalence of HF was 1.7% in France and has increased until the COVID-19 pandemic and decreased thereafter. The incidence of acute HF decompensation reached 201.4 per 100000 inhabitants and has decreased since 2012 (-1% per year). A significant increase of the HF incidence was found in men aged <45years. Women aged <65years were less likely to be admitted in a cardiac rehabilitation (CR) unit and had higher probability of one-year mortality compared with men of the same age. One-year mortality was significantly increased in patients from the most deprived area among extreme age group only (under 65 and ≥85years). One-year rehospitalization rates have decreased significantly, particularly in men aged <75years. A decrease in ACE/ARBs deliveries was observed in both men and women. Despite the decrease in acute HF decompensation incidence and improvements in the management, the prevalence of HF remains stable in France and prognosis remains poor.

Abstract 12237: Transcatheter Aortic Valve Replacement in Very Low Gradient Aortic Stenosis

Introduction: Transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement is recommended for symptomatic patients with high-gradient aortic stenosis (HGAS) and certain patients with low-flow, low-gradient aortic stenosis (LGAS). While TAVI may be beneficial in LGAS (mean pressure gradient (MPG) &lt;40 mmHg), the outcomes of TAVI in very low-gradient AS (VLGAS) patients (&lt;25 mmHg) is under-reported. Methods: This retrospective cohort study analyzed 1269 patients who underwent TAVI at a multi-disciplinary, tertiary-care center. Patients with severe aortic stenosis were divided into VLGAS (≤25mmHg), LGAS (&gt;25 mmHg up to 40 mmHg) and HGAS groups (≥40 mmHg), using MPG derived from transthoracic echocardiography. Symptom improvement was measured by New York Heart Association (NYHA) functional classification at baseline, 30-days, and 1-year. Mortality and rehospitalization were secondary endpoints. Between group differences were evaluated with chi-squared tests. Results: Patients with VLGAS had improvement in NYHA functional class after TAVI that was similar to those with LGAS and HGAS (figure). While symptom improvement was similar between groups at 30 days (86% in VLGAS, 84% in LGAS and 85% in HGAS, p=0.46), VLGAS was associated with inferior symptom improvement at 1 year (76%, 87%, and 89%, respectively, p&lt;0.01). One-year rehospitalization rates were higher in patients with VLGAS than in patients with LGAS or HGAS (28%, 21%, and 17%, respectively, p =0.014). Mortality at 1-year did not differ between groups (p=0.65). Conclusion: TAVI improves symptoms in most LGAS patients, including those with VLGAS. More VLGAS patients with either no change or worsened symptoms after TAVI may be correlated to increased rehospitalization.

Don’t blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model

BackgroundEarly Intervention Services (EIS) aim to reduce relapse rates and achieve better treatment and functional outcomes for first episode psychosis (FEP) patients. Existing models of services in Greece are still treatment as usual (TAU), however a reform of mental health services is underway and initial steps have been taken to shift standard care towards EIS. The purpose of the study is to address therapeutic gaps by exploring service engagement and relapse rates in the current standard care model for psychosis.MethodsWe examined follow-up and relapse rates one year after initial treatment contact in the first longitudinal FEP study conducted in Greece. 225 patients were enrolled between 2015–2020. Sociodemographic, clinical and functional characteristics were assessed in association with follow-up and relapse rates.ResultsWithin a TAU follow-up setting, one year attrition rates were high. Only 87 patients (38,7%) retained contact with services after one year and within this time frame, 19 of them (21,8%) experienced a severe relapse requiring rehospitalization. Demographic, clinical and functional contributors failed to predict service engagement and relapse rates, with the exception of treatment adherence.ConclusionBoth follow-up and one-year rehospitalization rates in our FEP sample, highlight the need for the implementation of early intervention services, that will aim at engagement maximization and relapse prevention. These indexes also provide a benchmark against which future early intervention services for psychosis in Greece will have to demonstrate superior efficacy.

Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects.

Background: Patterns of real-world antiplatelet therapy (APT) are reported to differ from guideline recommendations. This study describes patterns of APT during the year following a hospital diagnosis of acute coronary syndrome (ACS) and possible implications in terms of revascularization rates, rehospitalizations, and costs for the Italian National Health Service. Methods: From >5 million people, patients discharged (=index date) with primary/secondary ACS diagnosis in 2017 were identified by cross-linkage of administrative health data collected by the Ricerca e Salute (ReS) Foundation. Patients were characterized by revascularization rates at index date, APT at one month and one year (with appropriate coverage defined as ≥80% of defined daily doses), and rehospitalizations and healthcare costs during follow-up. Results: From the 2017 ReS database, 7966 (1.46 × 1000 inhabitants) were discharged alive with an ACS diagnosis. Most were >69 years and male. Of these, 83% (6640/7966) received ≥1 recommended antiplatelet agent within one month (treated group): 23% (1870/7966) as single and 60% (4770/7966) as dual APT. Among the 53% undergoing revascularization, 81% received dual APT at one month. Of the 78% with the same APT at one year, 66% showed appropriate coverage. For subjects treated and untreated with APT at one month, one-year rehospitalization rates were 54% and 66%, respectively, and mean per capita costs were EUR 14,316 and EUR 16,552, respectively (hospitalization driving >80% of costs). Conclusions: Among survivors of a hospitalized ACS diagnosis, this analysis shows relatively high APT under-treatment at one month and one year, associated with fewer index revascularization rates, more rehospitalizations, and greater costs. Further initiatives to understand undertreatment and poor adherence should lead to improved health management and savings.

P.2.d.005 - One-year rehospitalization rates in bipolar disorder manic patients discharged on mood stabilizers versus mood stabilizer combined with antipsychotics

P.2.d.005 - One-year rehospitalization rates in bipolar disorder manic patients discharged on mood stabilizers versus mood stabilizer combined with antipsychotics

Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry

ObjectivesAlthough diabetes mellitus is frequently associated with heart failure (HF), the association between elevated admission glucose levels and adverse outcomes has not been well established in hospitalized patients with acute HF. MethodsWe prospectively evaluated in-hospital mortality, post-discharge 1-year mortality and 1-year re-hospitalization rates in the Italian Network on Heart Failure (IN-HF) Outcome registry cohort of 1776 patients hospitalized with acute HF and stratified by their admission glucose levels (i.e., known diabetes, newly diagnosed hyperglycemia, no diabetes). ResultsCompared with those without diabetes (n=586), patients with either known diabetes (n=749) (unadjusted-odds ratio [OR] 1.64, 95%CI 0.99–2.70) or newly diagnosed hyperglycemia (n=441) (unadjusted-OR 2.34, 95%CI 1.39–3.94) had higher in-hospital mortality, but comparable post-discharge 1-year mortality rates. After adjustment for age, sex, systolic blood pressure, estimated glomerular filtration rate, left ventricular ejection fraction, HF etiology and HF worsening/de novo presentation, the results remained unchanged in patients with known diabetes (adjusted-OR 1.86, 95%CI 1.01–3.42), while achieved borderline significance in those with newly diagnosed hyperglycemia (adjusted-OR 1.81, 95%CI 0.95–3.45). One-year re-hospitalization rates were lower in patients with newly diagnosed hyperglycemia (adjusted-hazard ratio 0.74, 95%CI 0.56–0.96) than in other groups. ConclusionsElevated admission blood glucose levels are associated with poorer in-hospital survival outcomes in patients with acute HF, especially in those with previously known diabetes. This finding further highlights the importance of tight glycemic control during hospital stay and address the need of dedicated intervention studies to identify customized clinical protocols to improve in-hospital survival of these high-risk patients.

Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure.

Objectives:To study sex differences in clinical characteristics and outcomes among multi-ethnic Southeast Asian patients with hospitalized heart failure (HHF).Background:HHF is an important public health problem affecting man and women globally. Reports from Western populations suggest striking sex differences in risk factors and outcomes in HHF. However, this has not been studied in a multi-ethnic Asian population.Methods:Using the population-based resources of the Singapore Cardiac Data Bank, we studied 5,703 consecutive cases of HHF admitted across hospitals in the Southeast Asian nation of Singapore from 1st January, 2008 through 31st December, 2009.Results:Women accounted for 46% of total admissions and were characterized by older age (73 vs. 67 years; p<0.001), higher prevalence of hypertension (78.6 vs. 72.1%; p<0.001) or atrial fibrillation (22.2 vs. 18.1%; p<0.001), and lower prevalence of coronary artery disease (33.8 vs. 41.0%; p<0.001) or prior myocardial infarction (14.9 vs. 19.8%; p<0.001). Women were more likely than men to have HHF with preserved ejection fraction (42.5% versus 20.8%, p < 0.001). Women were less likely than men to receive evidencebased therapies at discharge, both in the overall group and in the sub-group with reduced ejection fraction. Women had longer lengths of stay (5.6 vs. 5.1 days; p<0.001) but similar in-hospital mortality and one-year rehospitalization rates compared to men. Independent predictors of mortality or rehospitalization in both men and women included prior myocardial infarction and reduced ejection fraction. Among women alone, additional independent predictors were renal impairment, atrial fibrillation, and diabetes. Prescription of beta-blockers and ACE-inhibitors at discharge was associated with better outcomes.Conclusion:Among multi-ethnic Asian patients with HHF, there are important sex differences in clinical characteristics and prognostic factors. These data may inform sex-specific strategies to improve outcomes of HHF in Southeast Asians.

Is combined myocardial performance index and tricuspid annular plane systolic excursion a better predictive estimator than each of them alone in patients with inferior ST-elevation myocardial infarction?

We aimed to assess the combined estimator of left ventricular (LV) myocardial performance index (MPI) and tricuspid annular plane systolic excursion (TAPSE) as a pooled independent predictive factor for hospital mortality and one-year mortality and re-hospitalization in patients with primary LV inferior ST segment elevation myocardial infarction (STEMI). We prospectively studied 221 consecutive patients (189 males, 32 females; mean age 58.2±4.5; range 38 to 72 years) with primary LV inferior STEMI. Standard echocardiography and Doppler myocardial imaging were used within 24 hours of onset of myocardial infarction to measure LV MPI and TAPSE. Based on LV MPI and TAPSE values, all subjects were categorized into two groups: Group 1 with LV MPI ≥0.55 and TAPSE ≤14 mm (n=78) and Group 2 with the remaining patients (n=143). Patients were followed up for the endpoints of hospital mortality, one-year mortality and one-year re-hospitalization. Hospital mortality (17.9% vs. 6.3%, adjusted odds ratio [OR(adj)] 3.26, p<0.01) one-year mortality (39.1% vs. 14.2%, OR(adj) 3.88, p<0.001) and one-year re-hospitalization rates (50.0% vs. 18.7%, OR(adj) 4.36, p<0.001) were significantly higher in Group 1 than in Group 2. Compared with OR for LV MPI ≥0.55 vs. LV MPI <0.55 or TAPSE ≤14 mm vs. TAPSE >14 mm alone, the pooled parameter of LV MPI ≥0.55 and TAPSE ≤14 mm was shown to be the better predictive estimator, with higher OR and lower significance p-values. In primary LV inferior STEMI patients, combined LV MPI ≥0.55 and TAPSE ≤14 mm was seen to be a more valuable prognostic estimator than LV MPI ≥0.55 or TAPSE ≤14 mm alone for stratifying risky patients.

Antipsychotic Formulation and One-Year Rehospitalization of Schizophrenia Patients: A Population-Based Cohort Study

OBJECTIVE The authors compared the efficacy of long-acting injectable antipsychotics and oral antipsychotics on rehospitalization rate of community-dwelling patients with schizophrenia who had frequent admissions. METHODS The cohort study of 14,610 patients was conducted by analyzing the Taiwan National Health Research Institutes data. The patients were divided into groups that received oral antipsychotics (risperidone, a different second-generation antipsychotic, or a first-generation antipsychotic) or long-acting injectable antipsychotics (risperidone, haloperidol, or flupenthixol). RESULTS One-year rehospitalization rates of the final cohort of 10,552 patients were the same for both groups (by long-acting injection, 27.3%; by oral administration, 27.3%). Secondary analysis of groups receiving long-acting injectable medication showed that haloperidol resulted in lower rehospitalization rates (haloperidol, 22.5%; risperidone, 27.1%; and flupenthixol, 29.5%). Patients' characteristics, including age, region, and insurance payments were significantly correlated with the risk of relapse (p&lt;.05). CONCLUSIONS Except for injectable haloperidol, long-acting injectable antipsychotics seem not to be superior to oral antipsychotics in reducing rehospitalization.

Rehospitalization rates of patients with bipolar disorder discharged on a mood stabilizer versus a mood stabilizer plus an atypical or typical antipsychotic

One-year rehospitalization rates of patients with bipolar disorder discharged on a mood stabilizer alone, a mood stabilizer plus a typical antipsychotic, or a mood stabilizer plus an atypical antipsychotic were examined. Time to rehospitalization was measured by using the product-limit (Kaplan-Meier) formula. Twenty-three percent of patients on a mood stabilizer alone, 27% of patients on a mood stabilizer plus a typical antipsychotic, and 25% of patients on a mood stabilizer plus an atypical antipsychotic were rehospitalized within 1 year of discharge. There were no significant differences in rehospitalization rate or time to rehospitalization between groups. One-year rehospitalization rates for patients on a mood stabilizer plus olanzapine or risperidone were 25%. The number of previous psychiatric hospitalizations contributed to the risk of readmission. Risk factors and medication costs should be considered when designing the optimal treatment plan for an individual patient. Long-term prospective studies are needed to better delineate the effectiveness of different pharmacotherapeutic regimens on the long-term treatment outcomes in patients with bipolar disorder.