Predictors Of Rehospitalization In Patients Research Articles

Depression, anxiety, and quality of life as predictors of rehospitalization in patients with chronic heart failure

BackgroundChronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2–3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients.Methods148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint.ResultsIt was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001), while the anxiety values ​​were dependent on the occurrence of chronic obstructive pulmonary disease (COPD). However, levels of depression (HADS-Depression) and anxiety (HADS-Anxiety) did not correlate with the risk of rehospitalization. Univariate logistic regression analysis results showed that rehospitalized patients had significantly lower levels of Bodily pain (BP, p = 0.014), Vitality (VT, p = 0.005), Social Functioning (SF, p = 0.007), and General Health (GH, p = 0.002). In the multivariate model, poor GH (OR 0.966, p = 0.005) remained a significant risk factor for rehospitalization, and poor General Health is singled out as the most reliable prognostic parameter for rehospitalization (AUC = 0.665, P = 0.002).ConclusionTaken together, our results suggest that QoL assessment complements clinical prognostic markers to identify CHF patients at high risk for adverse events. Clinical Trial Registration: The study is registered under http://clinicaltrials.gov (NCT01501981, first posted on 30/12/2011), sponsored by Charité – Universitätsmedizin Berlin.

Predictors of Rehospitalization in Patients with Chronic Heart Failure a Single Center Study in Moroccan Patients

Chronic heart failure (HF) is a major problem of public health in Morocco with few studies exploring HF particularities in this country where the prevalence of HF is estimated to be around 2.2%.
 Objective: The aim of this study was to evaluate the correlation between frequency of rehospitalization in our population with age, left ventricular ejection fraction (LVEF), heart rate (HR), and QRS duration, Since the number of rehospitalizations is strongly correlated to mortality as shown by many studies.
 Materials and Methods: Patients with HF were enrolled in this retrospective case control study regardless of their LVEF, patients with recent (<3months) myocardial infarction were excluded. They were all examined and questioned in the heart failure unit of our hospital between the period of October 2022 and December 2022. The correlations were calculated by PEARSON index using R Statistical Software.
 Results: 224 patients were included. The mean patient age was 59 years (57.2-63;IC 95%) with a male predominance of 60.1 % (56.8-71; IC 95%). 35.5% and 32.2% of patients were treated for hypertension and diabetes respectively. The mean LVEF was 35.2% (33.96-36.91;IC 95%). A positive correlation was found between rehospitalization frequency and age and high heart rate (+ 0.42 p = 0,04;+0.322, p<0.005) respectively . Conversely a negative correlation was found with LVEF (-0.312, p<0.005) while there was a positive correlation with QRS duration but without significance (+0.162 , p=0.03).
 Conclusion: This study shows strong correlation between rehospitalization and advanced age, higher HR and lower LVEF.

Association of muscular fitness with rehospitalization for heart failure with reduced ejection fraction.

BackgroundLimited information is available regarding the prognostic potential of muscular fitness parameters in heart failure (HF) with reduced ejection fraction (HFrEF).HypothesisWe aimed to investigate the predictive potential of knee extensor muscle strength and power on rehospitalization and evaluate the correlation between exercise capacity and muscular fitness in patients newly diagnosed with HFrEF.MethodsNinety nine patients hospitalized with a new diagnosis of HF were recruited (64 men; aged 58.7 years [standard deviation (SD), 13.2 years]; 32.3% ischemic; ejection fraction, 28% [SD, 8%]). The inclusion criteria were left ventricular ejection fraction <40% and sufficient clinical stability to undergo exercise testing. Aerobic exercise capacity was measured with cardiopulmonary exercise testing. Knee extensor maximal voluntary isometric contraction (MVIC) and muscle power (MP) were measured using the Baltimore therapeutic equipment system. The clinical outcome was HF rehospitalization.ResultsOver a mean follow‐up period of 1709 ± 502 days, 39 patients were rehospitalized due to HF exacerbation. HF rehospitalization was more probable for patients with diabetes and lower oxygen uptake at peak exercise (peak VO2), knee extensor MVIC, and MP. The Kaplan–Meier survival analysis revealed significantly different cumulative HF rehospitalization rates according to the tertiles of peak VO2 (P = 0.005) and MP (P = 0.002). Multivariable Cox proportional hazard model showed that the lowest tertiles of peak VO2 (hazard ratio (HR), 6.26; 95% confidence interval (CI), 1.93–20.27); and MP (HR, 5.29; 95% CI, 1.05–26.53) were associated with HF rehospitalization. Knee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF.ConclusionKnee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF.

Abstract 16892: Impact of Catheter-Directed Thrombolysis on Hospital Readmission Rates in Patients With Acute Proximal and Caval Deep Vein Thrombosis

Objective: To evaluate the readmission rate and identify the predictors of rehospitalization in patients with acute proximal and caval DVT. Background: Acute Deep Vein Thrombosis (DVT) is a significant cause of mortality and morbidity in the US that affects more than 600,000 patients each year. Catheter-directed thrombolysis (CDT) is a minimally invasive treatment option that improve acute symptoms as well as quality of life of patients with acute DVT. Methods: Patients with index hospitalization for acute proximal and caval DVT between 2016 and 2017 in the U.S. Nationwide Readmission Database were evaluated for the rates, predictors, and costs of unplanned readmission at 30 days. We used Cox proportional hazard model to determine predictors of 30 days readmissions. Results: This analysis included 58,306 patients (age&gt;=18 years) with index hospitalization for acute proximal and caval DVT; 8589 (14.7%) were readmitted within 30 days. The significant predictors for 30 day unplanned readmission were Malignancy (HR 1.60, 1.41-1.81), Charlson comorbidity index &gt; 3 (HR 1.43, 1.30-1.57), Insurance Medicare vs Private(HR 1.39, 1.25-1.57), Length of stay more than 2 days (HR 1.34, 1.24-1.45), and Acute Kidney Injury (HR 1.28, 1.17-1.40), COPD (HR 1.25, 1.13-1.38), Age (HR 0.77,0.70-0.85), Catheter directed thrombolysis ( HR 0.83, 0.76-0.90), and Acute Pulmonary Embolism(HR 0.83, 0.76-0.90)(Figure1). The cost of readmission was higher than index hospitalization ($ 56733 vs $ 47396). Conclusion: The 30 days readmission rate continue to be high in patients with acute DVT. Patient’s characteristics and comorbid conditions are predictors of readmission. Use of Catheter directed thrombolysis for treatment of acute DVT predicts reduced readmission risk.

Sleep apnea in heart failure: in search of a better prognosis predictor

Abstract Background Sleep apnea (SA) is a burdensome and often underdiagnosed condition in heart failure (HF). Portable devices, such as ApneaLinkTM, are currently validated as a screening tool for SA. The apnea-hypopnea index (AHI) as been long considered the gold-standard measurement for the diagnosis of SA, also having a prognosis impact. Recently, however, other respiratory variables have been proposed as better prognosis predictors in patients with HF. The main goal of this study was to assess the prognostic value of other respiratory measurements evaluated by ApneaLinkTM at discharge in a population admitted for HF. Methods This was a single-center retrospective study enrolling consecutive patients admitted in a HF Clinic for acute HF from 2013 and 2018. All stable patients without previously known sleep-disordered breathing underwent ApneaLinkTM screening the night before discharge in the euvolemic state. Those with a total respiratory evaluation time &amp;lt;180 minutes or in need of supplemental oxygen were excluded. A primary endpoint of long-term HF hospitalizations was evaluated. Results Overall, 231 patients (mean age 74.5±10.6 years; 47% male; 83% hypertension; 41% chronic kidney disease; 44% anemia; 18% with a NYHA&amp;gt;2 at discharge; 43% ischaemic HF; 41% with a left ventricle ejection fraction lower than 50%) were assessed. One-hundred and sixty-nine patients (59.1%) had an AIH &amp;gt;15, with a median of 19 (IQR 7–42); the median number of obstructive apneas and central apneas was 13 (IQR 2–68), and 2 (IQR 0–10), respectively. Two-hundred patients (69.9%) had nocturnal periods of an oxygen saturation below 85% (T85), with a median time under that value of 8 (IQR 0–47) minutes. Over a median follow-up of 34.1 (IQR 18.40–54.37) months, 105 (45.7%) patients died and 128 (55.7%) were readmitted for AHF. After adjustment for cofounders (namely, the presence of anemia) a T85 above the 75th percentile was significantly correlated with a higher risk of HF readmission in a multivariate analysis (adjusted HR: 1.58, 95% CI: 1.08–2.30, p=0.017) (figure 1). These results were independent of the apnea-hypopnea index. Conclusion Nocturnal hypoxemia (T85) was an independent predictor of rehospitalization in patients with HF. These results further validate the utility and prognosis impact of other respiratory measurements (other than AHI) evaluated by ApneaLinkTM screening at discharge in a population of patients admitted for HF. Figure 1 Funding Acknowledgement Type of funding source: None

P2263Prognostic impact of perceived social isolation in patients with heart failure

Abstract Background Perceived social isolation (SI), the subjective sense of feelings of loneliness or isolation, has a negative impact on health outcomes, particularly in older adults. Although SI may also contribute to poor prognosis in patients with HF, evidence on the relationship between SI and outcomes in patients with HF is limited. Purpose The aim of this study was to investigate the relationship between SI and hospital readmission in patients with HF. Methods This study was a single center prospective cohort study. We consecutively enrolled 203 patients (mean age 72.9±11.7) who admitted for acute HF or exacerbation of chronic HF. At hospital discharge, we assessed perceived SI by using Lubben Social Network Scale - 6 (LSNS-6). Lower scores in LSNS-6 represents greater SI. Study outcome was rehospitalization for worsening HF within 180 days after discharge. We selected the optimal cutoff point of LSNS-6 that predict a worse outcome by the receiver operating characteristic (ROC) curve analysis. We investigate the association between SI and 180-days HF rehospitalization by using Cox proportional-hazard models, controlling for potential confounding factors. Results During follow up, A total of 40events (19.7%) were observed. The optimal cut-off point of LSNS-6 score was 17 points (the area under the ROC curve: 0.62, p&lt;0.05, sensitivity: 82.5%, specificity 42.4%). Kaplan-Meier survival curves showed that those patients with greater SI (LSNS-6≤17) presented significantly higher HF rehospitalization rate (Figure). After adjusting for several pre-existing prognostic factors, LSNS-6≤17 was independently associated with HF rehospitalization (hazard ratio2.15,95% confidence interval 1.00–4.89). Conclusion The present study shows that SI is a independent predictor of HF rehospitalization in patients with HF. Assessing SI in the clinical practice with a brief screening tool may help identify patients with heart failure at greater risk of rehospitalization.

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 &gt;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

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.

Predictors of re-hospitalization in patients with chronic heart failure

Heart failure (HF) is a chronic, progressive illness that is highly prevalent in the United States and worldwide. This morbid illness carries a very poor prognosis, and leads to frequent hospitalizations. Repeat hospitalization in HF is both largely burdensome to the patient and the healthcare system, as it is one of the most costly medical diagnoses among Medicare recipients. For years, investigators have strived to determine methods to reduce hospitalization rates of HF patients. Despite such efforts, recent reports indicate that re-hospitalization rates remain persistently high, without any improvement over the past several years and thus, this topic clearly needs aggressive attention. We performed a key-word search of the literature for relevant citations. Published articles, limited to English abstracts indexed primarily in the PubMed database through the year 2011, were reviewed. This article discusses various clinical parameters, serum biomarkers, hemodynamic parameters, and psychosocial factors that have been reviewed in the literature as predictors of re-hospitalization of HF patients. With this information, our hope is that the future holds better risk-stratification models that will allow providers to identify high-risk patients, and better customize effective interventions according to the needs of each individual HF patient.

The Congestive Hepatopathy is an Independent Predictor of Early Re-hospitalization in Patients With Chronic Heart Failure

The Congestive Hepatopathy is an Independent Predictor of Early Re-hospitalization in Patients With Chronic Heart Failure