Predictors Of Rehospitalization Research Articles

Predictors of rehospitalization in a naturalistic cohort of patients with bipolar affective disorder.

There has only been limited research into the predictors of readmission in bipolar disorder. We carried out a 1-year follow-up of patients discharged from a single mental health unit following admission for treatment of an acute bipolar episode. Of 519 patients followed up for 1 year, 167 (32.2%) were readmitted. There was no association between readmission and any drug regimen. Prescription of antidepressants at discharge was not associated with increased risk of readmission [odds ratio (OR): 0.99, 95% confidence interval (CI): 0.98-1.01]. Among demographic factors, only smoking (OR: 1.75, 95% CI: 1.14-2.75) and age range of 42-53 years (OR: 1.99, 95% CI: 1.15-3.43) conferred an increased risk of readmission. Individually optimized drug treatment regimens are equally effective in practice. It is not clear why smoking is associated with readmission.

Predictors of rehospitalization among older adults: Results of the CRIME Study.

To assess the predictors of readmission among older adults hospitalized in acute care wards. A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics. We analyzed all factors at discharge that could be considered predictors of readmission. The mean age of the participants was 81.2years (SD 7.4years), and 509 were women (55.3%). Overall, 280 of 921 patients (30.4%) were rehospitalized during the 1-year follow up of the study. Patients with a Mini-Mental State Examination score equal to or higher than 24 had a higher probability of rehospitalization, as compared with those who performed lower than 24 (OR 1.76, 95% CI 1.04-2.83). In addition, heart failure (OR 1.77, 95% CI 1.14-2.24), the number of falls during 1-year follow up (OR 1.15, 95% CI 1.05-1.28) and the number of drugs during first hospitalization (OR 1.15, 95% CI 1.01-1.07) were significantly associated with rehospitalization, whereas no significant association was shown for age, sex and walking speed for minimum size (OR 1.15, 95% CI 0.99-2.00). Predictors of readmission in older people are an intact cognitive status; the presence of a geriatric condition, such as heart failure and falls; and a high number of drugs during first hospitalization. Further studies are required to assess the impact of home care for avoiding readmission in patients with an intact cognitive status, and supporting and treating patients with dementia. Geriatr Gerontol Int 2017; 17: 1588-1592.

Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study.

AimsThe aims of the study were to study the demographical and clinicopathological characteristics of patients presenting with heart failure and evaluate the 1 year outcomes and to identify risk predictors if any.Methods and resultsA prospective observational study was conducted in consecutive patients of systolic heart failure. The study was divided into two parts—an initial 6 month enrolment phase followed up for 1 year for major adverse cardiovascular events. All patients were treated according to the Institutional Heart Failure Protocol. Demographical and clinicopathophysiological characteristics were studied, and results were analysed. A total of 143 patients were enrolled. The mean age of subjects was 56.4 years with male subjects constituting almost two‐thirds of the study population. The commonest aetiology of heart failure was ischemic with valvular heart disease being the commonest cause of non‐ischemic heart failure. Bendopnea, a recently described symptom of heart failure, was found in a significant number of subjects. By univariate analysis, male sex (P = 0.042) and cardiomegaly (P = 0.035) were predictors of rehospitalization, whereas the univariate predictors of mortality were ischemic aetiology (P = 0.000), age > 50 years (P = 0.007), hypertension (P = 0.012), worsening NYHA class (P = 0.003), diabetes mellitus (P = 0.009), and hypokalaemia (P = 0.006). Multivariate analysis performed showed age > 50 years [P = 0.007; OR (CI) = 13.547 (2.034–90.238)], NYHA class [P = 0.002; OR (CI) = 32.300 (3.733–276.532)], and hypokalaemia [P = 0.031; OR (CI) = 7.524 (1.208–46.862)] as significant predictors of mortality during long‐term follow‐up.ConclusionsThe study will definitely help us to throw more light in identifying risk predictors of heart failure and help in improving clinical outcomes.

Predictors of Rehospitalization Among Adults With Congenital Heart Disease Are Lesion Specific.

Readmission is responsible for a large proportion of inpatient care costs in adult congenital heart disease. There are, however, few data available to identify at-risk patients or to suggest strategies for intervention to prevent rehospitalization. We conducted an analysis of admissions in patients over the age of 18 years with a 3-digit International Classification of Diseases-Ninth Revision code of 745 to 747 from the State Inpatient Databases of Arkansas (2008-2010), California (2003-2012), Florida (2005-2012), Hawaii (2006-2010), Nebraska (2003-2011), and New York (2005-2012). We investigated index admission diagnoses most commonly associated with 1-year readmission and the most common reasons for readmission. We then selected variables we thought would be associated with increased rates of 1-year readmission and constructed multivariable regression models grouping patients by congenital lesion, to examine the relative contribution of the specified variables to readmission risk for each lesion. A total of 64 420 patients were included in the final analysis. Thirty-nine percent of patients experienced a readmission within 12 months of an index admission. Compared with those who did not experience a readmission, those who did were more likely to have had a primary diagnosis of congestive heart failure at the time of index admission, and the most common diagnoses at the time of readmission were congestive heart failure and arrhythmia. There is lesion-specific heterogeneity in risk factors for readmission. Patients with adult congenital heart disease have high rates of readmission, predominantly for congestive heart failure and arrhythmia. Predictors of readmission are lesion specific, and future strategies aimed at decreasing readmission rate will likely need to be individualized.

Abstract 332: Characteristics of Patients with Submassive Pulmonary Embolism with Early Re-hospitalization After tPA Administration

Background: Evidence for clinical predictors of early re-hospitalization after tissue plasminogen activator (tPA) therapy in patients with submassive pulmonary embolism (SMPE) is currently lacking. We sought to explore the characteristics of these patients in a retrospective cohort study at our hospital Methods: Clinical, biochemical, hemodynamic, echocardiographic characteristics and clinical course of consecutive patients with SMPE [as defined by Acute PE without systemic hypotension (systolic blood pressure >90 mm Hg) but with either Right Ventricular strain/dysfunction demonstrated on echocardiography obtained within 24 hours of presentation or myocardial necrosis as evidenced by elevated cardiac troponins and/or elevated brain natriuretic peptide levels)] were studied in a retrospective cohort study. Unplanned all cause re-hospitalizations after the index hospitalization for SMPE were captured Results: A total of 145 (in past 5 years) patients with pulmonary embolism diagnosed with spiral CT angiography or ventilation perfusion scan were screened for patients with SMPE. 17 patients with SMPE were identified in whom tPA was administered. No patient had major bleeding, one patient suffered gross hematuria during the tPA administration. After a mean 2.1 years of follow up 5 (29%) patients suffered unplanned all cause re-hospitalizations among which 4 were within one year from the index hospitalization for SMPE. Baseline characteristics are shown in table 1. No patients had recurrent PE after the index hospitalization Conclusion: A significant proportion of patients were re-hospitalized within one year after tPA administration in patients with SMPE. Further studies in larger cohorts are needed to identify independent clinical predictors of re-hospitalization in patients with submassive pulmonary embolism

Nonalcoholic Fatty Liver Disease Is Associated With Higher 1-year All-Cause Rehospitalization Rates in Patients Admitted for Acute Heart Failure.

Repeat hospitalization due to acute heart failure (HF) is a global public health problem that markedly impacts on health resource use. Identifying novel predictors of rehospitalization would help physicians to determine the optimal postdischarge plan for preventing HF rehospitalization. Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for many heart diseases, including HF. We assessed whether NAFLD at hospital admission predicts 1-year all-cause rehospitalization in patients with acute HF.We enrolled all patients consecutively admitted for acute HF to our General Medicine Division, from January 2013 to April 2014, after excluding patients with acute myocardial infarction, severe heart valve diseases, malignancy, known liver diseases, and those with volume overload related to extracardiac causes. NAFLD was diagnosed by ultrasonography and exclusion of competing etiologies. The primary outcome of the study was the 1-year all-cause rehospitalization rate.Among the 107 patients enrolled in the study, the cumulative rehospitalization rate was 12.1% at 1 month, 25.2% at 3 months, 29.9% at 6 months, and 38.3% at 1 year. Patients with NAFLD had markedly higher 1-year rehospitalization rates than those without NAFLD (58% vs 21% at 1 y; P < 0.001 by the log-rank test). Cox regression analysis revealed that NAFLD was associated with a 5.5-fold increased risk of rehospitalization (adjusted hazard ratio 5.56, 95% confidence interval 2.46–12.1, P < 0.001) after adjustment for multiple HF risk factors and potential confounders.In conclusion, NAFLD was independently associated with higher 1-year rehospitalization in patients hospitalized for acute HF.

The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure

BackgroundMore than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF....

Re-hospitalization of Psychiatric Residents of a Long-stay Care Home

The aim of this study was to examine independent variables such as socio-demographic, psychopathologic, and rehabilitative support background that might predict re-hospitalization among psychiatric residents of a long-stay care home (LSCH) in Hong Kong. The re-hospitalization of psychiatric residents with mental health needs who were admitted to a long-stay care home during a 2-year period was analyzed retrospectively in this study. Descriptive statistics were gathered to study the distribution of the sample data. Logistic regression was used to examine the predictors of re-hospitalization. 176 residents (mean age 56.9, SD 8.4 years) were included, of whom 73% were male. The psychopathologic characteristics of most residents were similar in that 94.9% of them had been diagnosed with schizophrenia. Within the 2-year period the incidence of re-hospitalization among the LSCH residents was 267 out of a population of 1,000. Gender, age, a history of suicide attempts, referral from an acute psychiatric setting, and lack of participation in a rehabilitative training program were the predictors of re-hospitalization. Strategic interventions to improve the current rehabilitative support services of LSCHs are discussed.

Abstract 12535: Decreased Six-Minute Walk Distance at Hospital Discharge, Its Cut-off Value of 370 Meters, is an Independent Predictor for Poor Activities of Daily Living After Discharge in Elderly Patients With Chronic Heart Failure

Background: Elderly patients with chronic heart failure (CHF) is well known to have poor activities of daily living (ADL) after hospital discharge because of their prolonged hospital stays and subsequent physical deconditioning. Although many studies demonstrated that decreased six-minute walk distance (6MWD) was an independent predictor of rehospitalization and mortality in them, the relationship between decreased 6MWD and poor ADL is not thoroughly evaluated. The purpose of this study was to investigate whether decreased 6MWD measured at hospital discharge reflected poor ADL after discharge in elderly patients with CHF. Methods: We recruited 290 patients, 179 males and 111 females, who were 65 years or more and admitted to our hospital because of first heart failure. We excluded the patients who had needed assistance with ADL or walking aid before admission. Plasma brain natriuretic peptide, left ventricular ejection fraction, 6MWD and motor functions including isometric quadriceps strength and one-leg standing time were measured at hospital discharge. ADL was evaluated using the performance measure for ADL-8 (PMADL-8) 3 months after discharge, while PMADL-8 score of 20 or more indicated poor ADL. To determine significant predictors affecting poor ADL and their cut-off values, a multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve were performed. Results: Patients’ mean age was 75.4 ± 6.4 years old and their mean PMADL-8 and 6MWD were 18.9 ± 5.9 points and 379 ± 109 meters, respectively. The univariate logistic regression analysis showed that age, 6MWD, quadriceps strength, one-leg standing time were significant predictors for PMADL-8 of ≥20 points (P&lt;0.05, respectively). The multivariate logistic regression analysis detected only 6MWD as a significant and independent predictor for PMADL-8 of ≥20 points (P&lt;0.001). The odds ratio of poor ADL was 1.16 (95% confidence interval: 1.10-1.25, P&lt;0.001) with each 10-meter decrease of 6MWD. The ROC curve showed 370 meters as a cut-off value of 6MWD. Conclusions: Decreased 6MWD at hospital discharge was identified as an independent strong predictor for poor ADL after discharge in elderly patients with CHF, and its cut-off value was 370 meters.

Incomplete leaflet coaptation and tricuspid regurgitation mechanism in right ventricular Tako-Tsubo cardiomyopathy

Tako-Tsubo cardiomyopathy (TTC) is a well-known form of acuteand reversible heart failure due to either an emotional or a physicalstressor,whichinvolvesmainlytheleftventriclewithatypicalechocar-diographic pattern (apical ballooningand basal hyperkinesis) [1].Rightventricular(RV)involvementhasaprevalenceof25%[2].Aclinicalcase,a short literature review and possible explaining mechanism areprovided.An86-yearoldwoman,withoutcardiovascularriskfactorsandwithhistory of bipolardisorder [3] cameto the emergency department afteran episode of syncope. At admission blood pressure was 70/50 mm Hg,ECG showed atrial fibrillation and ST-elevation in anterior and lateralleads (V2–V4, DI, aVL) (Fig. 1). Troponin I levels were increased(4.54 ng/ml, n.v. b 0.10). Trans-thoracic echocardiogram showed leftventricular (LV) systolic dysfunction (ejection fraction of 25%),akinesisofLVmidventricularsegments,dyskinesisofRVapicalsegmentsandin-complete coaptation of tricuspid leaflets (Video 1). At color-Dopplermild mitral regurgitation and severe tricuspid regurgitation werefound (Figs. 2 and 3, Video 2). Coronary angiography showed diffuseatherosclerosis not needing coronary intervention. Echocardiographyanomalies gradually recovered and the patient was discharged after acouple of weeks (Figs. 4 and 5) (Video 3). Discharge electrocardiogramshowed negative T-waves in anterior leads previously interested byST-elevation and diffuse decrease in QRS amplitude [4].Despite TTC affects mainly left ventricle, RV involvement is presentinoneoutoffourpatientsaffectedbyTTC.Severalechocardiographicstudies described acute mitral regurgitation and its clinical impor-tance in TTC[5], but, to the best of our knowledge, possible mecha-nism of tricuspid regurgitationduring RV TTC was never describedbefore.We report a case of RV apical dyskinesis causing traction of thepostero-lateral papillary muscle and consequent compromised coapta-tion of thetricuspid valve leaflets (Fig. 2);that could have led to severetricuspid regurgitation completely reversible after RV recovery.The mechanism of RV regurgitation seems to be different from thatwe have previously described in the left ventricle. LV basal hyperkinesis, consequent mitral valve area reduction and mitral leafletsredundancy may lead to LV outflow tract obstruction, increased intraventricular pressure and mitral regurgitation [6,7]. Systolic anteriormotion and tethering have been shown as independent predictors ofacute mitral regurgitation in patients with TTC [8].In thecaseof mid-LVballooning, rightward movement of midseptalsegmentsmayhaveincreasedRVpressure,thusimpairingRVgeometryand kinesis, and precipitating RV ballooning.Tricuspid regurgitation has not yet been evaluated as a marker ofprognosisinTTC;however,inacutemyocardialinfarctionoftheinferiorwall, moderate tricuspid regurgitation, affecting about one third ofpatients, is a predictor of rehospitalization at one-year follow-up [9].Although no in-hospital complication was present in our case, RVsystolic dysfunction represents an independent predictor of worseprognosis and is associated with a higher rate of in-hospital complica-tion both in inferior myocardial infarction [10] and TTC [2].Haghiet al. found in 34 patients with TTC that RV involvement is associatedwith a severe impairment in LV systolic function and a higher rate ofbilateral pleural effusion [2]. Elesber et al. showed in a population of30patientswithTTCthatRVinvolvementcarriesahigherriskofseverecongestive heart failure and longer in-hospital stay [11].We therefore believe that a systematic evaluation of RV function byechocardiogram is recommended for an optimal management of pa-tients with TTC. When an impaired LVEF is associated with abnormalRV function, there is a higher risk of hemodynamic complications.Therefore a strict monitoring is required and an early therapeuticstrategy including diuretics, levosimendan infusion and intra-aorticballoon pump counterpulsation should be considered [12–14].In conclusion, RV involvement in TTC may lead to severe tricuspidregurgitationduetoincompletecoaptationofvalveleaflets.This finding

Predictors of Rehospitalization in Patients Admitted With Heart Failure in Abeokuta, Nigeria: Data From the Abeokuta Heart Failure Registry

ObjectiveWe sought, for the first time, to examine the rate and predictors of hospital readmission in patients discharged after an episode of heart failure (HF) in Nigeria. MethodsThis was a hospital-based, prospective, observational study that used the data from the Abeokuta HF Registry. ResultsOverall, 1.53% (95% confidence interval [CI] 0.58–4.02) and 12.2% (95% CI 8.88–16.8) of patients were re-hospitalized at least once within 30 days and 6 months, respectively (5.3% had multiple readmissions); the latter comprised 21/138 men (15.2%) and 11/124 (8.9%) women. A total of 11 (4.2%) died (all of whom had been rehospitalized). Worsening HF (24 cases, 75%) was the commonest reason for readmission. Among others, factors associated with rehospitalization included presence of mitral regurgitation (odds ratio [OR] 2.37, 95% CI 1.26–4.46), age ≥60 years (OR 2.04, 95% CI 0.96–3.29), presence of tricuspid regurgitation (OR 1.77, 95% CI 0.86–3.61), and presence of atrial fibrillation (OR 1.34, 95% CI 0.59–3.03). However, on an adjusted basis, only female sex (adjusted OR 0.33, 95% CI 0.14–0.79; P = .014 vs male) and body mass index <19 kg/m2 (adjusted OR 3.74, 95% CI 1.15–12.16; P = .028 vs ≥19 kg/m2) were independent correlates of readmission during 6 months' follow-up. ConclusionsHF rehospitalization within 6 months' follow-up occurred in ∼12% of our cohort living an environment where HF etiology is predominately nonischemic and the HF population is relatively younger. Higher rates of readmission were noted in those with older age, lower body mass index, low literacy, lower serum sodium level, and presence of atrial fibrillation, renal dysfunction, and valvular dysfunction.

Predictors of rehospitalization after admission for pneumonia in the veterans affairs healthcare system

Although some factors associated with rehospitalization after community-acquired pneumonia have been identified, other factors such as medical care utilization and medication usage have not been previously studied. We investigated novel predictors of rehospitalization in patients admitted with pneumonia. Using Department of Veteran Affairs (VA) administrative data from October 2001 to September 2007, we examined a cohort of patients 65 years old and older, who were hospitalized with pneumonia, in 150 VA acute care hospitals. The cohort was randomly split into derivation and validation samples, and then logistic regression models were used to identify and validate predictors of all-cause rehospitalization within 30 days. Of the 45,134 subjects, 13% were rehospitalized within 30 days. No significant differences were noted between the derivation and validation cohorts. Factors associated with readmission included age, marital status, chronic renal disease, prior malignancy, nursing home residence, congestive heart failure, use of oral corticosteroids, number of emergency department visits a year prior, prior admission, number of outpatient clinic visits in a year prior, and length of hospital stay. The C statistics for the derivation and validation models were 0.615 and 0.613, respectively. Factors associated with readmission were largely unrelated to the underlying pneumonia, but were related to demographics, comorbidities, healthcare utilization, and length of stay on index admission.

Inferior vena cava parameters predict re‐admission in ischaemic heart failure

The clinical history of heart failure (HF) is usually characterized by frequent hospitalizations for decompensation. Therefore, several markers of subclinical hemodynamic congestion are under investigation for predicting early rehospitalization. In this field, the potential of ultrasound inferior vena cava (IVC) assessment has been recently investigated in HF but not yet assessed in the different aetiological categories. Forty-eight patients admitted for decompensated HF (n = 25 with ischaemic heart disease [IHD] and n = 23 non-IHD) underwent biochemical examination (including NT-proBNP), echocardiography and IVC assessment by hand-carried ultrasound (HCU). During 60-day follow-up after discharge, the re-hospitalization rate for HF was recorded to investigate the predictive power of NT-proBNP and IVC assessment among the two study groups. IHD and non-IHD patients with HF were similar except for gender distribution. During follow-up, 16·7% of patients were rehospitalized for decompensated HF, with higher prevalence in IHD group (28% vs. 4·3% P = 0·031). IVC assessment at discharge significantly predicted re-admission in the overall population and in IHD group, whereas NT-proBNP failed to predict rehospitalization in IHD group. In adjusted hazard ratio, only IVC min and the changes of IVC from admission significantly predicted re-admission. ROC analysis confirmed the change in IVC min as the best predictor of rehospitalization in patients with IHD. This pilot study showed a higher early re-admission rate in patients with HF due to IHD. In addition, the change in IVC min diameter from admission to discharge was the best predictor of re-admission in patients with IHD.

Readmission of Preterm Infants Less Than 32 Weeks Gestation Into Early Childhood: Does Gender Difference Still Play a Role?

The aim of the study was to investigate the frequency of and the predictors for rehospitalization in preterm infants into early childhood, focusing on gender differences. All preterm infants born at <32 weeks of gestation in North Tyrol between January 2003 and December 2005 were enrolled in this survey. About one fifth of all children were readmitted, showing an inverse downward trend with increasing age. The most common reason for readmission in the third (36.5%) and fourth (42.9%) years of life was respiratory infection, but changed to miscellaneous surgeries in the fifth (52.1%). Male sex showed significantly higher readmission rates and more miscellaneous surgeries. Additionally, male sex and chronic lung disease were risk conditions for rehospitalization in the multivariate analysis. Readmission rates and respiratory infections in preterm-born children showed an inverse downward trend with increasing age. In early childhood, gender difference still plays a role with regard to rehospitalization.

P.2.d.037 Rates and predictors of rehospitalisation in bipolar I patients three years after first admission

P.2.d.037 Rates and predictors of rehospitalisation in bipolar I patients three years after first admission

A Combined Marker of Inflammation in Individuals with Mania

BackgroundMarkers of immune activation have been associated with mania but have not been examined in combination. We studied the association between mania and an inflammation score based on four immune markers.MethodsA total of 57 individuals with mania were assessed at up to three time points: the day of hospital admission, evaluation several days later, and six-month follow-up. Also assessed were 207 non-psychiatric controls and 330 individuals with recent onset psychosis, multi-episode schizophrenia, or bipolar disorder depression. A combined inflammation score was calculated by factor analysis of the levels of class-specific antibodies to the NR peptide of the NMDA receptor; gliadin; Mason-Pfizer monkey virus protein 24; and Toxoplasma gondii. Inflammation scores among groups were compared by multivariate analyses. The inflammation score of the mania group at evaluation was studied as a predictor of re-hospitalization in the follow-up period.ResultsThe combined inflammation score of the mania group at hospital admission and at evaluation differed significantly from that of the non-psychiatric controls (t = 3.95, 4.10, p<.001). The inflammation score was significantly decreased at six month follow-up (F = 5.85, p = 0.004). There were not any significant differences in the inflammation scores of any of the other psychiatric groups and that of the controls. Within the mania group, an elevated inflammation score at evaluation predicted re-hospitalization (Hazard ratio = 7.12, p = .005).ConclusionsHospitalization for mania is associated with immune activation. The level of this activation is predictive of subsequent re-hospitalization. Interventions for the modulation of inflammation should be evaluated for the therapy of individuals with mania.

Hyperbilirubinemia - useful non-cardiac parameter of biventricular failure and negative prognosis in acute heart failure patients

Purpose: To identify the value of hyperbilirubinemia as a parameter of biventricular Heart Failure (HF) and prognostic marker and its relation to selected characteristics in general population of hospitalized Acute Heart Failure (AHF) patients. Methods: We used the data from SLOVASeZ, nationwide multicenter AHF survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia during 3 months. Hyperbilirubinemia was defined as serum bilirubine ≥ 25 μmol/L at admission. We analysed forty-eight variables in relation to clinical manifestation of AHF in univariate analysis. Significantly associated parameters (p < 0.05) were subsequently entered into linear regression model for multivariate analysis. Results: Hyperbilirubinemia was present in 151 patients (17.5%). Patients with hyperbilirubinemia were more often rehospitalized due to AHF (22.9 vs. 13.7%, p = 0.008) and had higher in-hospital mortality (12.6 vs. 5.6%, p = 0.007). Hyperbilirubinemia was also an independent predictor of in-hospital mortality (p < 0.01). There were ten significant parameters associated with hyperbilirubinemia in univariate analysis. Hyperbilirubinemia was significantly more common in men (28.1 vs. 10.7%, p < 0.001) and in patients admitted with AHF due to dilated cardiomyopathy (39.5 vs. 17.8%, p < 0.001), edema (23.5 vs. 15.5%, p = 0.01), hepatomegaly (32.8 vs. 15.4%, p < 0.001), jugular venous distension (30.6 vs. 15.5%, p < 0.001), hypotension – systolic blood pressure < 100 mmHg (38.5 vs. 18.7%, p = 0.002). Hyperbilirubinemia was also more frequent in patients with hyponatremia – serum sodium < 135 mmoL/l (38.1 vs. 17.3%, p < 0.001), left ventricular systolic dysfunction – ejection fraction ≤ 40% (26.4 vs. 15.7%, p = 0.003), severe mitral regurgitation (28.3 vs. 18.1%, p < 0.05) and those treated with inotropes (48.9 vs. 18.3%, p < 0.001). Parameters independently associated with hyperbilirubinemia were male gender and hyponatremia (for both p < 0.001) as well as severe mitral regurgitation (p < 0.05). Conclusion: Hyperbilirubinemia is a frequent and routinely available parameter in AHF patients. It is a reliable predictor of rehospitalizations due to AHF and in-hospital mortality, which is more than twice higher in hyperbilirubinemic AHF patients. Hyperbilirubinemia is more often associated with characteristics of biventricular HF and hypoperfusion what makes it useful non-cardiac parameter in detection of worse prognosis of these patients.

Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy, Functional Status, and Length of Stay

Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients admitted to in-hospital rehabilitation facilities after an acute hospitalization. In-hospital rehabilitation and aged care unit. Retrospective cohort study. Elderly patients 65 years or older admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June2011. The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, and length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of these risk factors for time to event within the 30-day follow-up. Among 2735 patients, with a median age of 80 years (interquartile range 74-85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (hazard ratio [HR], 3.94; 95% confidence interval, 1.62-9.54; P= .002) and a significant decline in functional status (56 points or more at the Barthel Index) compared with the month before hospital admission (HR 2.67, 95% CI: 1.35-5.27; P= .005). Additionally, a length of stay in the acute hospital of 13 days or more carried a twofold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39-5.10); P= .003). The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared with the month before acute hospital admission, and hospital length of stay are important risk factors.

Healthcare Utilization in Medical Intensive Care Unit Survivors with Alcohol Withdrawal

Rehospitalization is an important and costly outcome that occurs commonly in several diseases encountered in the medical intensive care unit (ICU). Although alcohol use disorders are present in 40% of ICU survivors and alcohol withdrawal is the most common alcohol-related reason for admission to an ICU, rates and predictors of rehospitalization have not been previously reported in this population. We conducted a retrospective cohort study of medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal using 2 administrative databases. The primary outcome was time to rehospitalization or death. Secondary outcomes included time to first emergency department or urgent care clinic visit in the subset of ICU survivors who were not rehospitalized. Cox proportional hazard models were adjusted for age, gender, race, homelessness, smoking, and payer source. Of 1,178 patients discharged from the medical ICU over the study period, 468 (40%) were readmitted to the hospital and 54 (4%) died within 1 year. Schizophrenia (hazard ratio 2.23, 95% CI 1.57, 3.34, p < 0.001), anxiety disorder (hazard ratio 2.04, 95% CI 1.30, 3.32, p < 0.01), depression (hazard ratio 1.62, 95% CI 1.05, 2.40, p = 0.03), and Deyo comorbidity score ≥3 (hazard ratio 1.43, 95% CI 1.09, 1.89, p = 0.01) were significant predictors of time to death or first rehospitalization. Bipolar disorder was associated with time to first emergency department or urgent care clinic visit (hazard ratio 2.03, 95% CI 1.24, 3.62, p < 0.01) in the 656 patients who were alive and not rehospitalized within 1 year. The presence of a psychiatric comorbidity is a significant predictor of multiple measures of unplanned healthcare utilization in medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal. This finding highlights the potential importance of targeting longitudinal multidisciplinary care to patients with a dual diagnosis.

Patient, provider and system factors influencing rehospitalisation in adults with heart failure

Objectives: To identify patient, provider and system factors predicting rehospitalisation in adults with heart failure (HF). Method: The electronic data bases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and PsychInfo were searched from 1996–2008 to identify studies identifying predictors of rehospitalisation from which the factors of patient, provider and systems were extracted. Results: A total of 62 elements were identified. These elements were then sorted into patient, provider and system categories. Risk factors identified for rehospitalisation were predominantly related to clinical factors. There were less factors identifying risk from the perspective of provider and health care systems. Conclusions: In people with HF it is likely that non-clinical factors including provider and system play an important role in rehospitalisation. There is a need to identify individuals at risk of rehospitalisation and tailor disease management programmes accordingly.