Readmission Rates For Patients Research Articles

Indication-based analysis of laser interstitial thermal therapy: a propensity score-matched comparison of outcomes for brain tumor versus epilepsy indications.

Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to ablate abnormal tissue in a targeted fashion. It is most commonly used to treat epileptic foci, brain tumors, and radiation necrosis. This study aimed to compare immediate postoperative outcomes between these indications. This study analyzed clinical data from the Nationwide Readmissions Database (NRD) from 2016 to 2019 and identified 2234 patients who underwent LITT procedures using ICD-10 codes. The authors analyzed patient demographics, complications, discharge disposition, readmission rates, and mortality. Following propensity score matching, 317 patients treated for epilepsy and 323 patients treated for brain tumors were compared. The mean ages were similar (epilepsy: 45.7 vs tumor: 49.0 years, p = 0.55), as were the proportions of female patients (epilepsy: 45.4% vs tumor: 52.9%, p = 0.83), all-payer costs (p = 0.81), income quartiles (p = 0.58), insurance types (p = 0.70), frailty rates (p = 0.85), and comorbid disease burdens as assessed by ECI score (p = 0.73). No significant differences were observed in rates of hemorrhage (p = 0.1), pulmonary embolism (p = 0.32), or infection (p = 0.16). However, the tumor cohort had higher rates of deep vein thrombosis (3.4% vs < 3.15%, p = 0.045), nonroutine discharge (26.6% vs 16.4%, p = 0.04), and 1-year hospital readmission (32.5% vs 18.6%, p = 0.006). One-year mortality rates were similar (tumor: 3.4% vs epilepsy: < 3.15%, p = 0.08). While postoperative complications and 1-year mortality rates were similar among patients undergoing LITT for epilepsy and brain tumors, the tumor cohort experienced higher rates of deep vein thrombosis, nonroutine discharge, and 1-year hospital readmission.

Forecasting Patient Early Readmission from Irish Hospital Discharge Records Using Conventional Machine Learning Models

Background/Objectives: Predicting patient readmission is an important task for healthcare risk management, as it can help prevent adverse events, reduce costs, and improve patient outcomes. In this paper, we compare various conventional machine learning models and deep learning models on a multimodal dataset of electronic discharge records from an Irish acute hospital. Methods: We evaluate the effectiveness of several widely used machine learning models that leverage patient demographics, historical hospitalization records, and clinical diagnosis codes to forecast future clinical risks. Our work focuses on addressing two key challenges in the medical fields, data imbalance and the variety of data types, in order to boost the performance of machine learning algorithms. Furthermore, we also employ SHapley Additive Explanations (SHAP) value visualization to interpret the model predictions and identify both the key data features and disease codes associated with readmission risks, identifying a specific set of diagnosis codes that are significant predictors of readmission within 30 days. Results: Through extensive benchmarking and the application of a variety of feature engineering techniques, we successfully improved the area under the curve (AUROC) score from 0.628 to 0.7 across our models on the test dataset. We also revealed that specific diagnoses, including cancer, COPD, and certain social factors, are significant predictors of 30-day readmission risk. Conversely, bacterial carrier status appeared to have minimal impact due to lower case frequencies. Conclusions: Our study demonstrates how we effectively utilize routinely collected hospital data to forecast patient readmission through the use of conventional machine learning while applying explainable AI techniques to explore the correlation between data features and patient readmission rate.

Explainable machine learning and multi-modal data for predicting readmission in patients with heart failure

Abstract Background Cardiovascular diseases (CVDs) are among the leading causes of mortality and morbidity globally, with an estimated 1 million hospital admissions for CVD in England in 2019/20, leading to 5.5 million bed days. In addition, patients with CVDs have a notably high rate of hospital readmission, with approximately one in four patients experiencing heart failure (HF) being readmitted within one month of discharge. We explored whether machine learning models trained on electrocardiogram (ECG) and patient electronic health records (EHRs) can support decision-making and risk management and ultimately improve health outcomes for HF patients. Purpose The project aims to develop a machine learning model to predict health outcomes for HF patients. To test the hypothesis, we trained and tested an explainable machine learning model to predict the risk of mortality and hospital readmission rate for HF patients. Methods We used EHR data and tabulated ECG records to train an XGBoost model to predict the risk of 30-day mortality and 30-day hospital readmission for HF patients. EHR data from a cohort of 2,868 patients with their ECG records were used for model development. We extracted a total of 78 features from the ECG data, such as heart rate variability (HRV), P-wave durations, and QT intervals. These ECG features were combined with coded and free-text EHR data (e.g., demographic information, diagnosis, medication history, and lab results) and used as tabular inputs to the XGBoost model. Of the 2,868 patients, an internal set of 574 patients stratified by age, sex, and health outcomes (30-day mortality and 30-day hospital readmission) were held out for testing. Results Among 2,868 HF patients with 10-year follow-up, 1065 patients were reported for mortality or hospital readmission within 30 days of discharge. When the machine learning model was trained on ECG data in addition to EHR data, the model was able to predict patient mortality and hospital readmission rate in the test set with an area under the curve (AUC) of 0.91 and 0.70, respectively. For mortality prediction, the model achieved a sensitivity and specificity of 0.81 and 0.82, respectively, when employing an operating point with minimum difference between the sensitivity and specificity. When the threshold was adjusted to favor sensitivity at 0.91, the model specificity decreased to 0.74. The machine learning model also identified high sensitive troponin levels, QT dispersion, and lactate dehydrogenase levels as features of high importance for predicting the outcomes for HF patients. Conclusions Our developed machine learning model was able to predict mortality and readmission risks in HF patients using multi-modal data. Upon further validation, the machine learning model has the potential to be tested for supporting clinical decision-making and risk management for HF patients.ROC CurveFeature Importance

30-Day Readmissions and the Need for Emergency Surgery Following Non-Operative Management of Perforated Diverticulitis.

Background: Limited data are available on the evaluation and outcomes of patients with perforated diverticulitis who were treated without surgery. Aims: This retrospective review was aimed at investigating the 30-day non-elective re-admission rates for patients hospitalized with perforated diverticular disease who were treated without surgery, rates of patients requiring surgery on re-admission, and the independent predictors of re-admission. Methods: A total of 143,546 patients from the National Readmission Database, between 2016 and 2020, who were admitted with perforated diverticulitis and treated non-operatively were reviewed. Re-admitted patients were compared with those not re-admitted. Comparisons for continuous and categoric variables were made using the student t-test and chi-squared test, respectively. A logistic regression model was used to determine independent factors associated with re-admission. All analyses were done with SAS 9.4; p values <0.05 identified significance. Results: Among patients with perforated diverticulitis who were treated non-operatively, 17,868 (12.4%) were re-admitted within 30 days and 4,924 (27.6%) of patients re-admitted required surgical intervention. The greatest independent predictors of re-admission include patient insurance status, index length of stay, undergoing a drainage procedure, and patient disposition. Comorbidities predicting re-admission include renal failure, chronic pulmonary disease, diabetes mellitus, fluid and electrolyte disorders, and hypertension. Hospital total charges were greater at the index admission for patients requiring re-admission. Conclusion: Non-operative management of perforated diverticulitis is safe for many patients, but the risks for re-admission and subsequent need for emergency surgery require special consideration.

The total joint arthroplasty care patterns in China during the COVID-19 pandemic: a multicenter cohort study.

The COVID-19 pandemic has profoundly affected the care practices of total joint arthroplasty (TJA) throughout the world. However, the impact of the pandemic on TJA care practices has not yet been studied in China. This retrospective multicenter cohort included patients aged 18 years or older who underwent TJA between January 2019 and December 2019 (prepandemic period) and January 2020 to December 2021 (pandemic period). Data were obtained from the medical records of 17 Chinese hospitals. Interrupted time series (ITS) analysis was used to estimate differences in monthly TJA volume, hospitalization proportion of TJA, preoperative characteristics, postoperative complications, 30-day readmissions, length of stay (LOS), and costs in inpatients undergoing TJA between the prepandemic and pandemic periods. Multivariate regression and propensity score matching (PSM) analyses were used to assess the impact of the COVID-19 pandemic on hospital complications, readmissions at 30 days, LOS, and costs at the patient level. A total of 752,477 inpatients undergoing TJA in the prepandemic period, 1,291,248 in the pandemic period, with an average 13.1% yearly decrease in the volume of TJA during the pandemic. No significant changes were observed in the proportion of hospitalizations for TJA. ITS analyses showed increases in the proportion of comorbidities (8.5%, 95% CI: 3.4-14.0%) and the number of comorbidities (15.6%, 95% CI: 7.7-24.1%) in TJA cases during the pandemic, without increasing LOS, costs, complications, and readmission rates. Multivariate and PSM analyses showed 6% and 26% reductions in costs and readmission rates during the pandemic, respectively. The COVID-19 pandemic was associated with more severe preoperative conditions and decreased volume, costs, and readmission rates in patients undergoing TJA in China. These findings demonstrate that the COVID-19 pandemic did not have a dramatic impact on the TJA care pattern in China, which may have resulted from active and strict strategies in combating COVID-19 as well as a rapid response in hospital management.

Application of the Clinical Outcomes, Healthcare Resource Utilization, and Related Costs Model in Chronic Obstructive Pulmonary Disease Patients

Introduction: The change in prevalence and management of chronic obstructive pulmonary disease (COPD) led to changes in outcomes and costs. We aimed to assess current clinical outcomes, resource utilisation, and costs in COPD. Methods: Retrospective, observational study of a cohort of consecutive COPD patients who visited the emergency department (ED) of a large tertiary hospital in 2018. The study measured baseline characteristics, 30-day and 1-year mortality, readmission, re-ED visit rates, and costs using the Clinical Outcomes, HEalthcare REsource utilisatioN, and relaTed costs (COHERENT) model, validated for heart failure. This model, featuring a colour graphic system, tracks time spent in different clinical situations (home, ED, hospital), considering vital status, healthcare resource use, and related costs. Results: In 2018, 2,384 patients with a primary COPD diagnosis visited the ED. The average age was 76 years, with 40% women. Observed mortality rates were 7.6% in-hospital, 8.5% at 30 days, and 23.4% at 1 year. The readmission rates were 9.9% and 36.1%, respectively. The cohort’s 1-year cost was approximately EUR 14.6 million (USD 15.95 million), with a median cost per patient of EUR 3,298 (USD 3,603.96). Hospitalisation incurred the highest costs, with initial hospitalisation and readmissions accounting for 44.7% and 42.6% of expenditures, respectively. Conclusion: One-year mortality and readmission rates for patients with COPD visiting the ED remain high with a significant economic impact on the health system. This burden justifies special programs to improve their care.

The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery.

Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.0%. In multivariate analysis, the overlap of probable sarcopenia and malnutrition was a significant predictor for the 30-day unplanned readmission (OR= 8.10, 95%CI= 1.20-0.55; p=0.032). ■ Probable sarcopenia plus malnutrition was significantly associated with unplanned readmission. ■ Overlap of probable sarcopenia and malnutrition was an independent risk factor for readmission. ■ Certification of whether the patient is malnourished and/or sarcopenic preoperatively is necessary. ■ SARC-F and subjective global assessment can effectively and easily assess sarcopenia and malnutrition at admission. To assess the 30-day unplanned readmission rate and its association with overlapping probable sarcopenia and malnutrition after major oncological surgery. A prospective bicentric observational cohort study performed with adult oncological patients undergoing major surgery. The primary outcome was unplanned readmission within 30 days after discharge and the association with probable sarcopenia and malnutrition. Nutritional status and probable sarcopenia were assessed just prior to surgery. Patients classified using subjective global assessment, as B and C were malnourished. Probable sarcopenia was defined using SARC-F (strength, assistance with walking, rise from a chair, climb stairs, falls) questionnaire ≥4 points and low HGS (handgrip strength) <27kg for males and <16kg for females. Two hundred and thirty-eight patients (51.7% female) with a median age of 60 years were included. The 30-day readmission rate was 9.0% (n=20). Univariate analysis showed an association of malnutrition (odds ratio (OR) = 4.84; p=0.024) and probable sarcopenia (OR = 4.94; p=0.049) with 30-day readmission. Furthermore, when both conditions were present, the patient was almost nine times more likely to be readmitted (OR = 8.9; p=0.017). Multivariable logistic regression analysis showed that overlapping probable sarcopenia and malnutrition was an independent predictor of 30-day unplanned readmission (OR = 8.10, 95% confidence interval (95%CI) 1.20-0.55; p=0.032). The 30-day unplanned readmission rate was 9.0%, and the overlap of probable sarcopenia and malnutrition is an independent predictor for the 30-day unplanned readmission after major oncologic surgery.

8152 Benefits of Inpatient Diabetes Management by a Specialized Diabetes Team

Abstract Disclosure: M. Bojarian: None. A. Ohri: None. C. Buettner: None. Background: Inpatient dysglycemia is associated with poor clinical outcomes such as prolonged length of stay (LOS), increased risk of ICU admission, and in-hospital mortality. The benefits of managing diabetic patients in the hospital with a dedicated diabetes team, as opposed to standard care on episodes of hypoglycemia or hyperglycemia, reduction in LOS, and 30-day readmission rates, remain uncertain. A potential confounder is the likelihood that patients receiving a diabetes consult may be sicker than those without a consult. Given the growing evidence supporting the role of specialized diabetes teams in improving care for diabetes patients, we sought to examine these benefits at our hospital. We plan to address confounding variables through propensity score matching. Objective: To assess whether diabetes patients experience reduced LOS, hypoglycemia, hyperglycemia, and 30-day readmission rates when managed by a specialized diabetes team compared to inpatients managed by a hospitalist team. Material and Methods: This quality improvement study compared LOS, hypoglycemia (glucose &amp;lt;70 mg/dL), hyperglycemia (glucose &amp;gt;180 mg/dL), and 30-day readmission rates in diabetes patients managed by a specialized diabetes team versus a hospitalist team at our hospital between June 2022 and December 2022. Results: 5676 patients with diabetes were admitted between June and December 2022 at our hospital, and a specialized diabetes team managed 417 patients (7.34%). In a preliminary analysis in which no propensity matching was performed yet, the 30-day readmission rate was significantly lower (87,16.6%) in patients who received a diabetes consult compared to patients who did not receive a diabetes consult (320,17.9%). The rate of hypoglycemia was higher (24.4%) in the specialized diabetes consult group than in the non-diabetes consults group (19.9%). Additionally, LOS was longer in patients with a specialized diabetes consult (7.1 vs. 3.1 days), and hyperglycemia (glucose &amp;gt;180 mg/dL) was more prevalent in the specialized diabetes consult group (78.9%) compared to the non-diabetes consult group (39.2%). Conclusion: In this retrospective analysis, patients managed by a specialized diabetes team showed lower readmission rates despite longer hospitalization and increased dysglycemic episodes. This could be attributed to sicker patients receiving diabetes consults, influencing dysglycemia rates. To account for such confounders, ongoing propensity score matching aims to provide a clearer understanding. Reduced readmission rates suggest improved care transitions, potentially resulting in significant cost savings for the healthcare system. Presentation: 6/1/2024

Risk factors for early readmission to hospital in patients with malignancy-related ascites: a retrospective cohort study.

Malignancy-related ascites (MRA) is a common serious complication of many advanced malignant tumors with high morbidity and mortality. The high hospital expenditures induced by unplanned readmission in patients with MRA have become an urgent issue to the public. We aimed to overall assess the unplanned early readmission rate of patients with MRA and explore the potential risk factors for such readmission. A retrospective cohort study based on 2018 Nationwide Readmissions Database was performed and patients with MRA were recruited into the analysis. The primary outcome was unplanned 30-day readmission rate and inpatient outcomes. The multivariate logistic regression analysis was performed to evaluate the potential risk factors for such early readmission. Data obtained from 32,457 patients with MRA were analyzed, and of these 7,799 individuals (24.03%) were unplanned readmitted within 30-day follow-up. The mortality rate in the readmitted population was 15.15%. Patients at younger age were at a higher risk of readmission. The morbidities including hypertension (OR=1.117, 95%CI: 1.054-1.184), hyperlipemia (OR=1.075, 95%CI: 1.009-1.146) and diabetes (OR=1.118, 95%CI: 1.053-1.188), gastrointestinal malignancies and peritoneal procedure significantly increased the risk of 30-day readmission in patients with MRA. More than one in five patients with MRA was unplanned readmitted within 30-day follow-up. The above risk factors should be timely intervened and the corresponding medical care should be strengthened in patients with MRA to lessen the unplanned readmission and improve the readmission outcomes.

Community paramedicine program and outcomes of referred coronary artery bypass grafting patients.

Community paramedicine is a field in its infancy. The use of community paramedics has expanded in recent years as an alternative or adjunct to home health in the continued drive to decrease health disparities and complications. In current practice, they function in a position like a home healthcare nurse with an expanded scope of practice, such as providing specialized follow-up care, for example with postoperative care for patients who have undergone major surgery or recent hospitalization. This study assesses if community paramedics are a valid option in reducing rehospitalization of patients who underwent a coronary artery bypass grafting (CABG) procedure. A retrospective chart review between 2021 and 2022 was performed on all patients who underwent CABG in Bismarck, North Dakota, along with obtaining a referral for the community paramedics spanning urban and rural areas. A comparison was made between individuals who saw the community paramedics in their post-care versus those who continued with the standard of care. There were 80 participants and 38 location-matched controls. All variables were found to be statistically insignificant except for the number of walk-in visits (urgent care), in which 7 out of 38 sought medical attention in the controls and 4 out of 80 sought medical attention in the participants. The proportions of inpatient readmission rates and emergency department (ED) visits were similar. Given that paramedicine is in its infancy, the emergence of other variations of the community paramedic certification has brought a discussion of their scope of practice. While walk-in visits, even with the limitations, showed significant improvement with the addition of community paramedics, more research is still needed to show their effectiveness in reducing readmission to hospital. Additionally, the patients who sought help from community paramedics may be more likely than the controls to seek help from medical professionals. This study provided a novel look into the effect that community paramedics can have on patients in urban and rural areas in regard to reducing postoperative complications and minimizing unnecessary advanced healthcare utilization.

Bouncing Back: Hospital Reliance On Transitional Care Beds – A Disservice To Patients? A Review Of Readmission Rates

Abstract Background The Health Service Executive (HSE) developed an Urgent and Emergency Care (UEC) Operational Plan in 2023. One UEC action was an aim to transfer “clinically appropriate” patients to alternative care settings e.g. Transitional Care Beds (TCBs) to relieve pressure caused by high occupancy rates in acute hospitals. Inclusion criteria for TCB use is ill defined and we sought to evaluate their usage. Methods Retrospective analysis of characteristics and readmission rates (RAR) of patients discharged from a tertiary hospital to TCB from Oct 1st, 2023 - Jan 1st, 2024. Results 158 patients were discharged from hospital to TCBs. 49% (n=77) were female, mean [SD] age 77.82 [10.09] years. The median length of stay (LOS) was 15 days. 50% (n=79) were discharged from surgical services, 40.5% (n=64) from medical teams, 8% (n=13) from oncology services, 7% (n=11) from geriatric medicine and 1% (n=2) from ED. 27% (n=43) had a “fall” documented as their discharge diagnosis. 32% (n=51) of patients were readmitted within 90 days, 11% (n=18) within 30 days and 4% (n=6) within 14 days. 30% (n=15) were readmitted directly from TCB. Average time between discharge and readmission was 44.7 days. Median LOS on readmission was 10 (IQR 15.5 days). 9% (n=14) had an eventual discharge to long term care (LTC) either from a subsequent admission or transitioned directly from TCB. 6% (n=10) of patients died. Conclusion Of those readmitted, one third were directly from TCBs suggesting discharge to TCB may have been premature and patient selection inappropriate subsequently resulting costly readmissions. Although interventions are needed to relieve capacity pressure in hospitals, greater emphasis needs to be placed on access for patients to designated rehabilitation programmes. We should aim to support older adults following acute hospital admissions by carrying out comprehensive geriatric assessment to maximise independence and reduce likelihood of hospital readmission or transition to LTC.

Building capacity and capability for quality improvement: insights from a nascent regional health system

ObjectivesQuality improvement (QI) is critical in facilitating advancements in patient outcomes, system efficiency and professional growth. This paper aimed to elucidate the underlying rationale and framework guiding JurongHealth Campus (JHC),...

The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review.

Hospital readmissions pose a challenge for modern healthcare systems. Our aim was to assess the efficacy of telemedicine incorporating telemonitoring of patients' vital signs in decreasing readmissions with a focus on a specific patient population particularly prone to rehospitalization: patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) through a comparative effectiveness systematic review. Three major electronic databases, including PubMed, Scopus, and ProQuest's ABI/INFORM, were searched for English-language articles published between 2012 and 2023. The studies included in the review employed telemedicine incorporating telemonitoring technologies and quantified the effect on hospital readmissions in the HF and/or COPD populations. Thirty scientific articles referencing twenty-nine clinical studies were identified (total of 4,326 patients) and were assessed for risk of bias using the RoB2 (nine moderate risk, six serious risk) and ROBINS-I tools (two moderate risk, two serious risk), and the Newcastle-Ottawa Scale (three good-quality, four fair-quality, two poor-quality). Regarding the primary outcome of our study which was readmissions: the readmission-related outcome most studied was all-cause readmissions followed by HF and acute exacerbation of COPD readmissions. Fourteen studies suggested that telemedicine using telemonitoring decreases the readmission-related burden, while most of the remaining studies suggested that it had a neutral effect on hospital readmissions. Examination of prospective studies focusing on all-cause readmission resulted in the observation of a clearer association in the reduction of all-cause readmissions in patients with COPD compared to patients with HF (100% vs. 8%). This systematic review suggests that current telemedicine interventions employing telemonitoring instruments can decrease the readmission rates of patients with COPD, but most likely do not impact the readmission-related burden of the HF population. Implementation of novel telemonitoring technologies and conduct of more high-quality studies as well as studies of populations with ≥2 chronic disease are necessary to draw definitive conclusions. This study is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), identifier (INPLASY202460097).

Comparative analysis of readmission rates and outcomes: Sleeve gastrectomy with versus without Nissen fundoplication using a National Database.

Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure. To study the safety of LSG done with Nissen Fundoplication (NF) in patients affected by obesity and GERD and assess the complication rate. A retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2019. A total of 236111 patients underwent LSG with and without NF. A matched cohort of 1096 without NF and 548 with NF was obtained. The median age of patients was 47 years old. Median length of hospital stay was higher in the LSG with NF group. Median total charge was higher in the LSG with NF group. There was no statistically significant difference in 30-day readmission rates in patients with obesity and GERD who received LSG with NF compared to those who received LSG alone. Complications after both procedures were low, which highlights the safety of both procedures.

Insights into the Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors for the Length of Stay and Readmission in Chronic Heart Failure Patients.

This study evaluates the prognostic relationship between NLR, PLR, and, in a specific subcohort, N-terminal pro B-type natriuretic peptide (NT-proBNP), alongside length of stay (LOS) and 90-day readmission rates in CHF patients, irrespective of heart failure phenotype. A retrospective analysis of 427 CHF admissions (males = 57.84%) was conducted. The mean age of the entire population was 68.48 ± 11.53 years. The average LOS was 8.33 ± 5.26 days, with a readmission rate of 73 visits (17.09%) for 56 patients. The NLR (3.79 ± 3.32) showed a low but positive correlation with the LOS (r = 0.222, p < 0.001). Conversely, the PLR (144.84 ± 83.08) did not demonstrate a significant association with the LOS. The NLR presented a low negative correlation for days until the next admission (r = -0.023, p = 0.048). In a prespecified subanalysis of 323 admissions, the NT-proBNP exhibited a low positive Pearson correlation with the NLR (r = 0.241, p < 0.001) and PLR (r = 0.151, p = 0.006). The impact of the NLR across heart failure phenotypes may suggest the role of systemic inflammation in understanding and managing CHF.

Outcomes in acute decompensated chronic heart failure patients discharged with and without ivabradine: Advantages beyond heart rate control

&lt;p&gt;&lt;strong&gt;&lt;span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 宋体; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-ansi-language: EN-GB; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;"&gt;Background and Aim: &lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 宋体; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-ansi-language: EN-GB; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;"&gt;Ivabradine is indicated in chronic heart failure (HF) and reduced ejection fraction (EF) of &amp;lt; 35% and resting heart rate (HR) of &amp;gt; 70 bpm. However, role of Ivabradine in acute decompensated chronic HF (ADCHF) is not well known. The aim of this study was to evaluate one-year outcomes of ADCHF patients discharged with and without Ivabradine. &lt;strong&gt;Materials and Methods: &lt;/strong&gt;This is a prospective observational cohort study of ADCHF patients from January 2016 to January 2018. Main exclusion criteria was new onset de-novo acute HF, those with EF &amp;gt; 50% and atrial fibrillation. Data were analysed from 130 patients who were discharged with (62 patients) or without Ivabradine (68 patients). The primary end points were one-year re-hospitalization and cardiovascular mortality between two groups. &lt;strong&gt;Results:&lt;/strong&gt; The mean age of patients were 56 &amp;plusmn; 15 years and 61 &amp;plusmn; 17 years between Ivabradine and Non-ivabradine groups. EF upon discharge was 37.48% &amp;plusmn; 5.34% vs 40.01% &amp;plusmn; 8. 12%, with &lt;em&gt;p&lt;/em&gt;-value of 0.036. At discharge, higher HR was noted in patients with Ivabradine 84 &amp;plusmn; 13 bpm compared to 77.84 &amp;plusmn; 12. 13 bpm in patients without Ivabradine (&lt;em&gt;p&lt;/em&gt;-value = 0.006). After a year, HR in Ivabradine group was low compared to non-Ivabradine group, but was not statistically significant, 66.15 &amp;plusmn; 8 vs. 69.29 &amp;plusmn; 11.3 bpm, respectively. In the Ivabradine group 27.4% of patients visited emergency room (ER) more than once compared to 60.2 % without Ivabradine (&lt;em&gt;p&lt;/em&gt;-value = 0.0001). 9.7% of patients in Ivabradine group required one readmission compared to 55.9% without Ivabradine (&lt;em&gt;p&lt;/em&gt;-value = 0.0001). &lt;strong&gt;Conclusions: &lt;/strong&gt;In ADCHF patients there was significant reduction in ER room visit and re-admission rate in patients discharged with Ivabradine. Hence Ivabradine therapy may be considered in patients with ADCHF with EF &amp;lt; 50% and HR &amp;gt; 70 bpm to prevent re-hospitalization and save hospitalization costs.&lt;/span&gt;&lt;span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-IN; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;"&gt; &lt;/span&gt;&lt;/p&gt;

Healthcare Resource Utilization Following Acute Myocardial Infarction Findings from RECORD-MI Registry: Healthcare Utilization after Myocardial Infarction

The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis.

Comparison of machine learning models for predicting 30-day readmission rates for patients with diabetes

Comparison of machine learning models for predicting 30-day readmission rates for patients with diabetes

Self-management in patients with metabolic dysfunction-associated steatotic liver disease: influencing factors and impact on readmission

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease.ObjectiveThis study aimed to investigate the self-management ability of patients with MASLD, analyse related factors that may affect self-management ability and evaluate the impact of this ability on readmission.MethodsThe study recruited patients with MASLD admitted to the Department of Infectious Diseases, First Affiliated Hospital of Wenzhou Medical University, between February and October 2021 using the random sampling method. The MASLD diagnosis was based on the guidelines for the prevention and treatment of MASLD. An analysis of patients’ self-management ability was conducted using the self-management ability scale for patients with MASLD. Multiple linear regression analysis was used to analyse the factors influencing this self-management ability, and the readmission rate within 1 year was tracked. The patients were rediagnosed as having MASLD upon readmission to the hospital.ResultsA total of 241 baseline data items and self-management scale scores for patients with MASLD were collected and investigated. In our study, the normal score range for the self-management scale was 31–155 points, and the self-management scale scores for patients with MASLD was 91.24 ± 16.98, with a low level of self-management accounting for 52.7% and a medium level accounting for 44.8%. The results of the multiple linear regression analysis revealed that marital status, smoking history, fatty liver severity and education were the main factors affecting self-management ability (P < 0.05). The readmission rates were 18.25%, 7.48% and 0%, respectively, after 1 year of follow-up; the difference in survival distribution was statistically significant (P < 0.05).ConclusionThe self-management ability of patients with MASLD is relatively low and is primarily influenced by factors such as marital status, smoking history, the severity of fatty liver disease and level of education, which also affect the readmission rate of patients within 1 year.

Effect of Hope Theory combined with active cycle of breathing techniques on pulmonary rehabilitation among COPD patients: A quasi-experiment study

BackgroundPulmonary rehabilitation plays a positive role in improving exercise tolerance and reducing readmission rates in patients with chronic obstructive pulmonary disease (COPD), while the adherence of pulmonary rehabilitation in COPD patients is still poor. The active cycle of breathing techniques based on the Hope Theory is a method to enhance patients' confidence in overcoming the disease and improve the intrinsic motivation of exercise through symptom improvement such as cough and sputum evacuation ability. ObjectivesTo investigate the effect of Hope Theory education combined with the active cycle of breathing techniques on pulmonary rehabilitation of COPD patients, including exercise adherence, cough and sputum evacuation ability, hope index and exercise self-efficacy. MethodsThe study assigned 70 COPD patients hospitalized into intervention and control groups to receive the active cycle of breathing techniques based on Hope Theory or routine treatment in order of admission. Data for cough and sputum evacuation ability, hope, exercise confidence were collected at baseline and after the program. Exercise adherence was assessed at the end of 1, 4 and 8 week following discharge. ResultsThe actual number of sample consisted of 65 patients divided into intervention (n = 33) and control (n = 32) groups due to severe complications, explicit refusal, disinterest and loss to follow-up. After two weeks of intervention, exercise adherence of the intervention group were better than those of the control group at the end of 4 and 8 week of discharge (P < 0.05). And there was an improvement in cough and sputum evacuation ability, hope and exercise self-efficacy outcomes in the intervention group, with a statistically significant difference between the two groups (P < 0.05). ConclusionThe active cycle of breathing techniques based on Hope Theory education can improve cough and sputum evacuation ability, hope index, exercise self-efficacy, and exercise adherence of COPD patients.