Rehospitalization In Heart Failure Patients Research Articles

Association between triglyceride glucose-body mass index and long-term adverse outcomes of heart failure patients with coronary heart disease

BackgroundThe triglyceride glucose-body mass index (TyG-BMI) is recognized as a reliable surrogate for evaluating insulin resistance and an effective predictor of cardiovascular disease. However, the link between TyG-BMI index and adverse outcomes in heart failure (HF) patients remains unclear. This study examines the correlation of the TyG-BMI index with long-term adverse outcomes in HF patients with coronary heart disease (CHD).MethodsThis single-center, prospective cohort study included 823 HF patients with CHD. The TyG-BMI index was calculated as follows: ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. To explore the association between the TyG-BMI index and the occurrences of all-cause mortality and HF rehospitalization, we utilized multivariate Cox regression models and restricted cubic splines with threshold analysis.ResultsOver a follow-up period of 9.4 years, 425 patients died, and 484 were rehospitalized due to HF. Threshold analysis revealed a significant reverse “J”-shaped relationship between the TyG-BMI index and all-cause mortality, indicating a decreased risk of all-cause mortality with higher TyG-BMI index values below 240.0 (adjusted model: HR 0.90, 95% CI 0.86–0.93; Log-likelihood ratio p = 0.003). A distinct “U”-shaped nonlinear relationship was observed with HF rehospitalization, with the inflection point at 228.56 (adjusted model: below: HR 0.95, 95% CI 0.91–0.98; above: HR 1.08, 95% CI 1.03–1.13; Log-likelihood ratio p < 0.001).ConclusionsThis study reveals a nonlinear association between the TyG-BMI index and both all-cause mortality and HF rehospitalization in HF patients with CHD, positioning the TyG-BMI index as a significant prognostic marker in this population.

Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach.

Heart failure (HF) is a global problem, affecting more than 26 million people worldwide. This study evaluated the performance of 10 machine learning (ML) algorithms and chose the best algorithm to predict mortality and readmission of HFpatients by using The Fasa Registry on Systolic HF (FaRSH) database. ML algorithms may better identify patients at increased risk of HF readmission or death with demographic and clinical data. Through comprehensive evaluation, the best-performing model was used for prediction. Finally, all the trained models were applied to the test data, which included 20% of the total data. For the final evaluation and comparison of the models, five metrics were used: accuracy, F1-score, sensitivity, specificity and Area Under Curve (AUC). Ten ML algorithms were evaluated. The CatBoost (CAT) algorithm uses a series of decision tree models to create a nonlinear model, and this CAT algorithm performed the best of the 10 models studied. According to the three final outcomes from this study, which involved 2488 participants, 366 (14.7%) of the patients were readmitted to the hospital, 97 (3.9%) of the patients died within 1 month of the follow-up, and 342 (13.7%) of the patients died within 1 year of the follow-up. The most significant variables to predict the events were length of stay in the hospital, hemoglobin level, and family history of MI. The ML-based risk stratification tool was able to assess the risk of 5-year all-cause mortality and readmission in patients with HF. ML could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of critical features in the model.

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

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

Is vitamin D deficiency a risk factor for all-cause mortality and rehospitalization in heart failure patients?: A systematic review and meta-analysis.

The association of low 25-hydroxyvitamin D level with mortality and rehospitalization remains inconsistent in patients with heart failure. This systematic review and meta-analysis aimed to evaluate the value of blood 25-hydroxyvitamin D level in predicting all-cause mortality and hospitalization in heart failure patients. Two reviewers independently search the articles indexed in PubMed and Embase databases until November 30, 2021. Only the prospective or retrospective cohort studies evaluating the association of blood 25-hydroxyvitamin D level with all-cause mortality and rehospitalization in heart failure patients were selected. The predictive value of 25-hydroxyvitamin D level was summarized by pooling multivariable adjusted risk estimates for the bottom versus reference top 25-hydroxyvitamin D level. Seven studies with a total of 5941 patients with heart failure were identified. The pooled adjusted risk ratio (RR) of all-cause mortality was 1.37 (95% confidence interval [CI] 1.13-1.66), with significant heterogeneity (I2 = 70.5%; P = 0.002). However, there was no clear association between low 25-hydroxyvitamin D level and all-cause rehospitalization risk (RR 1.38; 95% CI 0.87-2.19). Low blood level of 25-hydroxyvitamin D may be an independent risk factor for all-cause mortality in patients with heart failure. Serum 25-hydroxyvitamin D level may provide prognostic information in heart failure patients. Additional randomized controlled trials are required to explore whether treatment of 25-hydroxyvitamin D deficiency by supplementation of vitamin D can improve survival in heart failure patients.

Rehospitalization rate and predictors of rehospitalization in heart failure patients in North Central Nigeria

Abstract &#x0D; Heart failure (HF) is a major cause of morbidity and mortality worldwide. Despite the advancement in its treatment the rate of rehospitalization of patients after treatment for HF is still high around the world. Studies assessing rehospitalization rates of HF patients are few in Nigeria. The objective of the study was to determine the 180-day rehospitalization rate and predictors of rehospitalization in acute HF patients managed in our Centre. The study was a retrospective cohort study of 148 patients with acute HF.&#x0D; The 180-day rehospitalization rate in our patients was 16.2%. The median time to rehospitalization was 61days. Serum urea (p=0.016), serum creatinine (p=0.033), admission eGFR &lt; 60mls/min/1.73m2 (p=0.007), LVEF (p=0.045) were associated with rehospitalization. eGFR &lt; 60mls/min/1.73m2 was an independent predictor of 180-day rehospitalization OR 5.4, (CI 1.701-7.690), p=0.014 suggesting 5 times greater likelihood of rehospitalization than patients with higher eGFR. The Kaplan-Meier survival curve for 180-day rehospitalization was plotted.&#x0D; In conclusion, the 180-day rehospitalization rate among our patients varies from other reported rates in our environment. Acute HF patients with renal dysfunction have a high likelihood of medium term rehospitalization and hence constitute an at-risk group for targeted intervention during admission.

Association of digoxin with mortality and rehospitalization in heart failure patients treated with beta-blockers: Results from the Persian Heart Failure Patient Registry.

Numerous clinical trials have reported conflicting results regarding the benefit of digoxin in treating heart failure (HF) patients. This study was conducted with the aim to demonstrate the impact of added digoxin to beta-blocker and beta-blocker alone on all-cause mortality and rehospitalization among these patients. We investigated the data of 1998 patients admitted with a primary diagnosis of decompensated HF in the prospective Persian Heart Failure Patients Registry in Iran. The outcomes of interest were time until death and time until first rehospitalization. Multivariate cox regression was used to compare the impact of beta-blocker plus digoxin and beta-blocker alone on 2.5-year survival and 90-day rehospitalization. The mean age of the participants was 69.18 ± 13.26 years, and 38.1% of patients were women. The incidence rate of all-cause mortality in the total sample was 0.18 and 0.22 in patients on beta-blocker plus digoxin and beta-blocker alone, respectively [incidence rate ratio (IRR) = 1.25; 95% CI: 0.92-1.7]. The adjusted risk of all-cause mortality was significantly higher in women discharged with beta-blocker plus digoxin than beta-blocker groups [hazard ratio (HR) = 2.31; 95% CI: 1.27-4.19]. Rates of 90-day first rehospitalization were 0.10 and 0.12 in the beta-blocker plus digoxin and beta-blocker alone groups, respectively (IRR = 0.85; 95% CI: 0.53-1.35). After adjustment for covariates, beta-blocker plus digoxin therapy had no significant effect on increasing the risk of 90-day first rehospitalization in the total cohort (HR = 0.77; 95% CI: 0.48-1.23), in men (HR = 0.73; 95% CI: 0.40-1.35), and women (HR = 0.76; 95% CI: 0.36-1.65). In patients hospitalized with decompensated HF, digoxin administration at discharge was associated with increased 30-month mortality risk in women.

75. MORE FREQUENT REHOSPITALIZATION IN HEART FAILURE PATIENTS WITH HYPERTENSION

Introduction: Heart Failure (HF) is the most common heart disease in the world and is increasing in prevalence. Despite the significant advances in therapies and prevention, mortality and morbidity are still high, poor quality of life and recurrent rehospitalization. Therefore, HF health expenditures are also considerable. Hypertension was the most common risk factor for CHF. However, no obvious data regarding recurrent rehospitalization in heart failure patients with hypertension in Indonesia Objective: The study aimed to compare recurrent rehospitalization of patients with heart failure with hypertension and without hypertension Method: We completed a descriptive analytic from heart failure registry of Dr Saiful Anwar Hospital. Baseline characteristic, hypertension treatment, length of stay, hospital mortality, recurrent rehospitalization and others data also analyze to compare between hypertension and non-hypertension patients. Result: A total of 1163 patients were included in this study. 28.5% of admitted HF patients suffered from hypertension. Interestingly, 27.9% of sample has been recorded as history of recurrent re-hospitalization. There was no significant difference in length of stay between heart failure patients with hypertension and without hypertension (mean = 6.68 ± 4.51; p = 0.453). However, the proportion of patient with hypertension experienced more frequent rehospitalization as compare non hypertension HF patient. Conclusion: HF patients with hypertension experienced more frequent hospitalization in this study

Food Deserts and Risk for Rehospitalization in Heart Failure Patients

Introduction Rehospitalization represents a financial burden on the healthcare system, estimated to be 17.4 billion dollars amongst Medicare recipients in 2004. The leading diagnosis for thirty day readmissions is for patients with congestive heart failure. Living in a socioeconomically disadvantaged neighborhood has been independently linked to increased rates of rehospitalization, with equivalent risk to having a diagnosis of chronic obstructive pulmonary disease. Lack of access to fresh fruits and vegetables in low-income areas, so called food deserts, has been linked to higher obesity rates, a risk factor for the development of congestive heart failure. While sodium restriction remains a recommendation in the ACC/AHA guidelines for the management of heart failure, data is inconsistent regarding the role of diet in symptomatic control. We hypothesized that distance to fresh produce and proximity to fast food may increase rate of admission for heart failure. Methods We created a dataset of all patients with an admission or discharge diagnosis of systolic heart failure from December 1st, 2010 to December 1st, 2015 at the University of Illinois Hospital. These patients were confirmed by chart review to have a left ventricular ejection fraction Results and Conclusions Patients were stratified by number of admissions, either having one or more than one admission. Patients with multiple admissions were found to have a grocery store closer to their home address (p=0.023) as well as more stores in a 5 mile radius (p=0.012) than patients with only one admission. Patients with multiple admissions were also found to have a significantly higher number of fast food restaurants in a 5 mile radius when compared to patients with only one admission (p=0.014). Availability of low sodium foods may be only a small factor in heart failure patient's dietary choices as patients with multiple admissions had more grocery stores within 5 miles and were closer to a grocery store. Patients with multiple admissions had significantly more fast food restaurants closer to their home, suggesting that taste preference, price and convenience play a significant factor in patient's dietary choices. It should also be mentioned that patients in all groups had more than twice the number of fast food restaurants near their home than grocery stores.

Predictors of infection-related rehospitalization in heart failure patients and its impact on long-term survival.

BackgroundInfection is the most common non-cardiovascular cause of re-hospitalizations for heart failure patients. We therefore investigated the predictors of infection-related re-hospitalization (IRRH) in heart failure patients and its impact on long-term survival.Methods and ResultsWe prospectively recruited 622 patients after the index hospitalization for decompensated heart fail with primary endpoints of IRRH and all-cause mortality. During follow-up of 3.9 ± 2.7 years, IRRHs occurred in 104 (16.7%) patients. Of the 104 patients who experienced IRRHs, the time from the index hospitalization to IRRH was 1.0 (interquartile range: 0.4–2.6) years. Independent predictors of IRRH were age (hazard ratio: 1.02, 95% confidence interval: 1.01–1.04), diabetes mellitus (2.12, 1.42–3.17), not taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (1.67, 1.01–2.78), needing maintenance therapy with a loop diuretic (2.10, 1.36–3.26), hemoglobin levels (0.87, 0.79–0.96), and estimated glomerular filtration rates (eGFRs) (0.99, 0.98–0.99). IRRH independently predicted all-cause mortality (1.99, 1.32–2.98) after adjusting for age, body mass index, New York Heart Association functional class, chronic obstructive pulmonary disease, brain natriuretic peptide, hemoglobin, and eGFR. The increased risk of death associated with IRRHs was predominantly for lower respiratory tract infections (3.71, 2.28–6.04), urogenital tract infections (2.83, 1.32–6.10), and sepsis (3.26, 1.20–8.85).ConclusionIRRHs in patients discharged for acute decompensated heart fail independently predicted worse long-term survival. We further identified independent predictors of IRRHs. These findings warrant future studies for tackling IRRH.

Minimal Invasive Pericardial Perfusion Model in Swine: A Translational Model for Cardiac Remodeling After Ischemia/Reperfusion Injury.

RationaleAdverse remodeling leads to heart failure after myocardial infarction (MI), with important impact on morbidity and mortality. New therapeutic approaches are needed to further improve and broaden heart failure therapy. We established a minimally invasive, reproducible pericardial irrigation model in swine, as a translational model to study the impact of temperature on adverse cardiac remodeling and its molecular mechanisms after MI.ObjectiveChronic heart failure remains a leading cause of death in western industrialized countries, with a tremendous economic impact on the health care system. Previously, many studies have investigated mechanisms to reduce infarct size after ischemia/reperfusion injury, including therapeutic hypothermia. Nonetheless, the molecular mechanisms of adverse remodeling after MI remain poorly understood. By deciphering the latter, new therapeutic strategies can be developed to not only reduce rehospitalization of heart failure patients but also reduce or prevent adverse remodeling in the first place.Methods and ResultsAfter 90 min of MI, a 12Fr dual lumen dialysis catheter was place into the pericardium via minimal invasive, sub-xiphoidal percutaneous puncture. We performed pericardial irrigation with cold or warm saline for 60 min in 25 female farm pigs after ischemia and reperfusion. After one week of survival the heart was harvested for further studies. After cold pericardial irrigation we observed a significant decrease of systemic body temperature measured with a rectal probe in the cold group, reflecting that the heart was chilled throughout its entire thickness. The temperature remained stable in the control group during the procedure. We did not see any difference in arrhythmia or hemodynamic stability between both groups.ConclusionWe established a minimally invasive, reproducible and translational model of pericardial irrigation in swine. This method enables the investigation of mechanisms involved in myocardial adverse remodeling after ischemia/reperfusion injury in the future.

Cystatin C for predicting all-cause mortality and rehospitalization in patients with heart failure: a meta-analysis.

Circulating cystatin C (cys-C/CYC) has been identified as an independent predictor of all-cause mortality in patients with coronary artery disease and the general population. This meta-analysis aimed to systematically evaluate the association between elevated cys-C level and all-cause mortality and rehospitalization risk amongst patients with heart failure (HF). PubMed and Embase databases were searched until December 2017. All prospective observational studies that reported a multivariate-adjusted risk estimate of all-cause mortality and/or rehospitalization for the highest compared with lowest cys-C level in HF patients were included. Ten prospective studies involving 3155 HF patients were included. Meta-analysis indicated that the highest compared with lowest cys-C level was associated with an increased risk of all-cause mortality (hazard ratio (HR): 2.33; 95% confidence intervals (CI): 1.67–3.27; I2 = 75.0%, P<0.001) and combination of mortality/rehospitalization (HR: 2.06; 95%CI: 1.58–2.69; I2 = 41.6%, P=0.181). Results of stratified analysis indicated that the all-cause mortality risk was consistently found in the follow-up duration, cys-C cut-off value or type of HF subgroup. Elevated cys-C level is possibly associated with an increased risk of all-cause mortality and rehospitalization in HF patients. This increased risk is probably independent of creatinine or estimated glomerular filtration rate (eGFR).

Hemodynamic and Hormonal Effects of Tolvaptan for Heart Failure

Tolvaptan (TLV) is a diuretic agent administrated for heart failure (HF) only in Japan. Many clinical findings have been obtained from the accumulation of clinical experience, and the administration of TLV reportedly avoids causing a reduction in the renal function. In addition, TLV has been reported to exert effects other than diuresis. The early start of TLV after hospitalization shortens the length of the hospital stay, and continuous TLV after discharge extends the period until re-hospitalization of HF patients. TLV is thought to function via vasopressin V2 receptor antagonism. However, no significant differences in the long-term prognosis were noted between the group using TLV and not using TLV in the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) trial, and effects other than diuresis are not useful for all HF patients. Therefore, it is necessary to identify patients who may experience effects other than diuresis with TLV administration. The accumulation of more patients and findings from further large-scale clinical trials will be necessary in order to clarify these points.

193 - Epidemiology of Arrhythmic Events in Heart Patients Immediately Post-Discharge, Insights From Mobile Cardiac Telemetry

Background: Heart failure (HF) is one of the most common reasons for hospital admission as well as re-hospitalization in the United States. One reason for re-hospitalization in HF patients are arrhythmic events. Moreover, arrhythmias confer a substantial risk of mortality and morbidity in patients with HF, and this represents a major healthcare burden worldwide. This project sought to describe the arrhythmia burden in HF patients immediately following a HF hospitalization. Methods: Patients admitted with acute decompensated HF were enrolled over a 13 month period beginning November 2015, and agreed to be monitored for 30 days post-discharge with a wireless cutaneous telemetry sensor. Clinicians were alerted using variables from the remote monitoring systems to evaluate and guide further assessment and intervention. Clinically significant arrhythmia prompted a phone call or home visit for additional assessment and intervention. Results: 31 patients participated in the program with a mean age of 78.5 years, 58% being 80 years old or older. 25/31 subjects had 1451 arrhythmic events (range: 0–474) during 665 total days of post-discharge monitoring (average 21.5 days/per patient). The most common arrhythmia was atrial fibrillation (453 episodes), while tachycardia, monomorphic VT, and junctional rhythm were the least common with 2 episodes each. Conclusions: HF patients immediately following a HF hospitalization have a wide variety and large number of arrhythmia events. Atrial fibrillation is the most common arrhythmia and may represent a target for early clinical intervention to prevent HF re-hospitalization.

Czynniki wpływające na rehospitalizacje pacjentów z niewydolnością serca

Heart failure (HF) is at present an important clinical problem. Hospitalization of HF patients causes that they have a much less favorable prognosis, and their successive rehospitalizations significantly affect the course of the disease and further treatment. The main reason for readmission to hospital is HF exacerbation, which from the pathophysiological point of view is associated with an elevated pressure in the pulmonary circulation. Factors affecting rehospitalization can be divided into: cardiac-related factors such as ischemia, atrial fibrillation, and uncontrolled hypertension, non-cardiac factors including coexisting diseases (especially chronic obstructive pulmonary disease, infections), patient- -related factors (nonadherence/noncompliance, self-care, frailty-syndrome, depression, cachexia) and healthcare system-related factors (nonadherence of physicians, therapeutic nihilism, insufficiency of interdisciplinary care system in the field of patients’ therapy and education). Rehospitalization of HF patients is a complex, multifactorial and not fully understood problem. An integrated interdisciplinary care system, which covers patients’ therapy, education, self- -assessment and self-control may reduce the mortality rate and number of rehospitalizations for all reasons and for HF.

Measured Physical Activity and 30-Day Rehospitalization in Heart Failure Patients.

Patients hospitalized with decompensated heart failure are at high risk for readmission within 30 days of discharge. Since physical inactivity is associated with increased health care utilization in other diseases, it may predict rehospitalization in heart failure. In a single-center, prospective study, physical activity was measured following hospital discharge using an accelerometer on the wrist. We then related this activity to the 30-day all-cause rehospitalization rate in heart failure. Each minute of activity was dichotomized into higher or lower intensity, based on a threshold of 3000 vector magnitude units. Counts above this threshold corresponded to a higher level of physical activity. Logistic regression and Kaplan-Meier survival analyses were used to relate the activity group to 30-day readmissions. Ninety-five patients admitted to a heart failure unit were screened; 61 met inclusion criteria and provided consent. Fifty patients were evaluated. Forty-six percent were male, mean age was 71 ± 15 years, and 46% had left ventricular ejection fraction <40%. Thirty-day all-cause hospitalizations occurred in 13 of these 50 patients (26%). Sixty-six percent and 34% were dichotomized into the higher and lower physical activity groups, respectively, over the first week; the latter were more likely to be readmitted within 30 days, with an OR = 5.0 (95% CI, 1.3-19.1), P = .02. Physical inactivity is related to 30-day all-cause readmissions for heart failure. Further studies are necessary to assess causality and to determine whether treatments directed at increasing physical activity could reduce readmission rate.

Galectin-3: a novel biomarker for the prognosis of heart failure.

Heart failure (HF) is still a global burden which carries substantial risk of morbidity and mortality. Thus, appropriate approach of diagnosis and layering the prognosis of HF are of great importance. In this paper we discuss and review a novel biomarker, which is called galectin-3 and already approved by Food and Drugs Administration (FDA) as a prediction tool for HF.Galectin-3, which is secreted by macrophages under the influence of mediators like osteopontin, has been known for its significant role in mediating cardiac fibrosis and inflammation. Numerous studies have shown galectin-3 as a novel prognostic biomarker with high predictive value for cardiovascular mortality and re-hospitalization in HF patients. However, there are also other contradictive studies displayed galectin-3 inferiority against other existed HF prognostic biomarkers like NT-proBNP and ST2. Nevertheless, galectin-3 has some advantages such as more stability and resistance against hemodynamic loading and unloading state, and also it could act as an early indicator of cardiac fibrosis, ventricular remodeling, and renal impairment in HF patients.

Abstract 13059: Diagnostic Performance of Left Ventricular Contractile Entropy in Patients With Heart Failure: Analysis by Quantitative Gated Semiconductor-SPECT

Background: Left ventricular (LV) dyssynchrony is considered as an important cause of congestive heart failure (CHF) admission. However, among the parameters of dyssynchrony, the prognostic value of LV contractile entropy is not elucidated. Hypothesis: Left ventricular contractile entropy can predict early re-hospitalization of heart failure patients. Method: Ninety-eight consecutive patients with first onset CHF who underwent quantitative gated demiconductor SPECT (QGS) before discharge were investigated retrospectively. Patients with re-hospitalization after discharge within 30-days were assigned to Group A, and patients without re-hospitalization were assigned to Group B. Data regarding electrocardiogram, and parameters of QGS including LV remodeling, systolic function, diastolic function and phase analysis (Phase SD, bandwidth, entropy) were collected automatically, and compared between Group A and B. Kaplan-Meier survival curves were used to compare variables between the patients, as appropriate. Multivariate analysis was performed on variables with a value of P &lt; 0.05 using the stepwise regression approach. Result (See figure and table): Of 98 patients, 92 patients did not readmit and other 6 patients readmitted within 30-days. ROC analysis showed that the cut-off value 0.785 predicted Group A (95% CI: 0.563-0.894) with 0.652 specificity and 0.833 sensitivity. Multivariate analysis showed that ‘entropy &gt; 0.785’ was a significant and independent predictor with a high odds ratio (OR:9.375, 95%CI :1.050-83.724). The Kaplan-Meier survival curve revealed a significant difference between the patients of ‘entropy ≧ 0.785’ and ‘entropy &lt; 0.785’ in 30-days re-hospitalization rate (Log-rank test, p=0.016). Conclusion: The LV contractile entropy was a powerful indicator of early phase re-hospitalization in patients with CHF, rather than ejection fraction or other parameters of LV dyssynchrony.

Dichotomous Relationship Between Age and 30-Day Death or Rehospitalization in Heart Failure Patients Admitted With Acute Decompensated Heart Failure: Results From the ASCEND-HF Trial

BackgroundYounger age as an independent predictor of death or all-cause rehospitalization at 30 days post-randomization for hospitalized heart failure (HF) patients has not been well described. Methods and ResultsASCEND-HF enrolled 7141 hospitalized acute HF patients (categorized by age: <45, 45 to <55, 55 to <65, 65 to <75, and ≥75 years) and followed them for 30 days to assess clinical outcomes, which included death or rehospitalization. Patients 45 to <55 years had the lowest percentages of death (1.4%) and total rehospitalizations (10.7%); percentages increased for younger (3.0% and 12.2%, respectively, for age <45 y) and older (5.8% and 12.5%, respectively, for age ≥75 y) patients. For those rehospitalized, the total HF-induced readmissions were highest in the youngest (68%) and declined with increasing age (P = .03). Although patients ≥55 years of age were more likely to die or be rehospitalized within 30 days of randomization for each additional 10 years of life, those <55 years of age had a significant reduction in death or HF rehospitalization for each 10-year increase in age (similar findings for death and HF rehospitalization). ConclusionsThere is a dichotomous relationship between age and risk of death or rehospitalization, and death or HF rehospitalization—risk decreases as age increases up to age 55 years, then increases after age 55 years.

Joint impact of clinical and behavioral variables on the risk of unplanned readmission and death after a heart failure hospitalization.

Most current methods for modeling rehospitalization events in heart failure patients make use of only clinical and medications data that is available in the electronic health records. However, information about patient-reported functional limitations, behavioral variables and socio-economic background of patients may also play an important role in predicting the risk of readmission in heart failure patients. We developed methods for predicting the risk of rehospitalization in heart failure patients using models that integrate clinical characteristics with patient-reported functional limitations, behavioral and socio-economic characteristics. Our goal was to estimate the predictive accuracy of the joint model and compare it with models that make use of clinical data alone or behavioral and socio-economic characteristics alone, using real patient data. We collected data about the occurrence of hospital readmissions from a cohort of 789 heart failure patients for whom a range of clinical and behavioral characteristics data is also available. We applied the Cox model, four different variants of the Cox proportional hazards framework as well as an alternative non-parametric approach and determined the predictive accuracy for different categories of variables. The concordance index obtained from the joint prediction model including all types of variables was significantly higher than the accuracy obtained from using only clinical factors or using only behavioral, socioeconomic background and functional limitations in patients as predictors. Collecting information on behavior, patient-reported estimates of physical limitations and frailty and socio-economic data has significant value in the predicting the risk of readmissions with regards to heart failure events and can lead to substantially more accurate events prediction models.

Association of Partner Status and Disposition With Rehospitalization in Heart Failure Patients

Sociodemographic variables that are predictors of rehospitalization for heart failure may better inform hospital discharge strategies. (1) To determine whether sociodemographic variables are predictors of hospital readmission, (2) to determine whether sociodemographic or laboratory variables differ by age group as predictors of readmission, and (3) to compare whether patients' discharge disposition differs by age group in predicting readmission. Retrospective chart review of hospitalized patients with heart failure admitted in 2007. Mean age was 68 (SD, 17) years for the 809 patients, with slightly more than one-third (n = 311, 38%) reporting a legal partner. Fewer than half (n = 359, 44%) were white. Almost one-third (n = 261, 32%) were rehospitalized within 90 days. Multivariable analysis revealed that patients younger than 65 years old and not partnered were at 1.8 times greater risk for being readmitted 90 days after discharge (P = .02; 95% CI, 0.33-0.92). Patients who were 65 years and older and not partnered were at 2.2 times greater risk for readmission (P = .01; 95% CI, 0.25-0.85) after creatinine level and discharge disposition were controlled for. For older patients discharged to home or to home with home services, the risk of readmission was 2.6 times greater than that for patients discharged to a skilled nursing facility (P = .02; 95% CI, 1.20-5.56). The absence of a partner was predictive of readmission in all patients. Older patients with heart failure who were discharged to a skilled nursing facility had lower readmission rates. The effect of partner and disposition status may suggest a proxy for social support. Strategies to provide social support during discharge planning may have an effect on hospital readmission rates.