Risk Of Rehospitalization Research Articles

Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart

ObjectivesTo evaluate the trend of prescription of the four foundational therapies, and their impact on 30-day urgent re-admissions and all-cause death in patients with heart failure and reduced ejection fraction...

Torsemide vs. furosemide in congestive heart failure: a systematic-review and meta-analysis on mortality and rehospitalization

Background Current guidelines suggest the use of loop diuretics as the preferred agent for decongestion in patients with heart failure. However, there is no clear evidence as to superiority of one loop diuretic over the other. The understanding of pharmacokinetic and pharmacodynamic superiority of torsemide over furosemide has generated the hypothesis that these features could result in better clinical outcomes. Objectives To determine whether the use of torsemide is associated with reduced risk for mortality and rehospitalizations in comparison to furosemide among patients with heart failure. Methods The study involves a comprehensive search of literature from PubMed, Cochrane CENTRAL, and ClinicalTrials.gov of clinical trials addressing the use of torsemide vs. furosemide in patients with heart failure. Pooled risk ratios (RR) were used to measure association for all outcomes with inverse-variance weighting and random effects model. Results The literature search included 188 studies that were screened individually. A total of 24 studies were identified out of which 12 were excluded. The pooled risk ratio (RR) revealed all-cause mortality of 0.98 [0.87 to 1.10] with 0% heterogeneity, all cause rehospitalization of 0.95 [0.88 to 1.02] with 5% heterogeneity, and heart failure rehospitalization of 0.85 [0.52 to 1.38] with 55% heterogeneity. Conclusion Considering the evidence from pooled randomised trials, the use of torsemide compared to furosemide did not result in statistically significant differences in all-cause mortality or rehospitalization rates.

Frailty in older adults admitted to hospital: outcomes from the Western Sydney Clinical Frailty Registry.

To examine baseline frailty and its association with rehospitalisation and mortality within 12 months among older adults enrolled in the Western Sydney Clinical Frailty Registry. Prospective observational cohort study. 592 adults admitted to an acute geriatric medicine service in NSW, Australia, were included in this study. The Western Sydney Clinical Frailty Registry is a study of adults admitted to acute geriatric wards in a 570-bed two-site district general hospital in Western Sydney, NSW, Australia. Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient and followed up for 12 months, including baseline visits and three-, six- and 12-month follow-ups via telephone interviews. The primary outcome of this study was rehospitalisation and/or mortality at 12 months. Median age 82 years; half the cohort were classified as mild-moderately frail, and 21% were classified as severely frail. A total of 134 participants died (22.6%) within the 12-month follow-up period. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p < 0.001) and Clinical Frailty Scale (CFS) scores (p < 0.001). Compared to the 'non-frail' group (CFS 1-4), those who were severely frail (CFS 7-9) had an 85% increased risk of rehospitalisation and/or death (95% CI 1.36-2.52), and those who were mild-moderately frail (CFS 5-6) had a 52% increased risk after adjusting for effects of the other variables (95% CI 1.18-1.94). Frailty is very common in older adults admitted to acute geriatric services. Assessing frailty using the CFS is feasible and is independently predictive of rehospitalisation and mortality. Our findings suggest that integrating frailty assessment into clinical practice goes beyond simple risk stratification, offering valuable insights for tailored clinical management strategies.

The impact of fruit and vegetable intake on healthcare costs and preventive care in older adults: evidence from SHARE data

Abstract Purpose This study aims to investigate the association between daily fruit and vegetable consumption and healthcare utilization among older European adults. Our findings inform policies aimed at optimizing healthcare resource allocation and promoting healthy ageing in Europe's growing elderly population. Methods Leveraging data from the 8th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) conducted in 2019–2020, this cross-sectional analysis examines associations between daily fruit and vegetable intake and hospitalization rates, hospital length of stay, visits to general practitioners, and specialist consultations. Results Our results reveal no significant difference in hospitalization probability between individuals consuming fruits/vegetables daily versus less frequently. However, among hospitalized individuals, daily consumption is associated with fewer hospitalizations and shorter hospital stays. Moreover, daily fruit and vegetable intake is positively associated with increased likelihood of consulting general practitioners and specialists. This association may be indicative of a broader health consciousness and proactive approach to well-being management among individuals who prioritize dietary choices. Conclusion These findings suggest that while fruit and vegetable consumption alone may not prevent hospitalizations in this segment of the population, it is linked to reduced re-hospitalization risk and shorter inpatient durations when hospitalized. Additionally, a diet rich in fruits and vegetables appears to promote greater engagement with preventive primary and speciality care among older European adults. Overall, the study highlights dietary behaviour as a potential factor influencing healthcare utilization and expenditures for ageing populations.

Clinical outcomes after transcatheter aortic valve implantation in nonagenarian patients: A retrospective population-based cohort study.

To compare the overall survival and the risk of all-cause and heart failure-specific hospitalization in nonagenarian patients hospitalized for symptomatic severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) or conservative treatment. Population-based retrospective cohort study based on healthcare utilization databases of the Italian region of Lombardy. The cohort included all nonagenarians hospitalized for AS between 2017 and 2021, who underwent TAVI within 90 days from first diagnosis or conservative treatment. The association between TAVI and clinical outcomes was assessed through Cox or Fine&Grey regression models. High-dimensional propensity score matching was used to reduce the heterogeneity between groups. Overall, 16,848 nonagenarians hospitalized for AS were identified. Among these, 320 patients underwent TAVI, of which 193 were matched to as many control patients. The 2-year survival rates were 76.0 % and 37.7 %, respectively, in TAVI and control patients, corresponding to an HR of 0.24 (95 % CI 0.15-0.37). The 2-year cumulative incidence of rehospitalization for heart failure was 11.1 % and 26.5 %, respectively, corresponding to an HR of 0.64 (95 % CI 0.40-0.99). This study further supports the usefulness of TAVI in nonagenarians, as it showed to improve their survival rate, reduce their risk of rehospitalization, and likely increase their quality of life.

Overall impact of tethering and of its symmetric and asymmetric subtypes on early and long-term outcome of transcatheter edge-to-edge repair of significant mitral valve regurgitation.

Tethering is a common condition of the mitral valve apparatus in the presence of significant regurgitation. Its impact on outcomes of transcatheter edge-to-edge repair (TEER) remains poorly characterized. We appraised the prevalence, features, procedural details, and outcomes of patients with or without mitral valve tethering in a prospective multicenter observational study. The primary endpoint was the risk of cardiac death or rehospitalization for heart failure at mid-term follow-up. We included 2238 patients, 1467 (65.5%) without tethering and 771 (34.5%) with tethering (487 [21.8%] with symmetric and 284 [12.7%] with asymmetric tethering). Several differences in baseline features were evident among groups, yet procedural results were similar. After a median of 14months, rates of cardiac death or rehospitalization for heart failure was significantly higher at unadjusted analysis in patients with tethering (191 [24.8%] vs. 272 [18.5%] in those without tethering, p=0.001), but weres similar between tethering subtypes (p=0.666). At adjusted analysis, the presence of any tethering was no longer a significant predictor of cardiac death or rehospitalization for heart failure, and the same results were obtained focusing on tethering subtypes (all p>0.05). Tethering is common among patients with an indication to TEER, and is associated with adverse baseline and procedural features. In spite of this, device and procedural success rates are not significantly impacted by the presence of tethering that does not even have a negative prognostic effect at follow-up. Accordingly, tethering should not be considered a contraindication to TEER in suitable patients.

MiR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study

Acute cardiogenic pulmonary edema (ACPE) is a common and serious manifestation of heart failure (HF), representing 10–20% of all acute HF admissions. It is associated with elevated in-hospital mortality and high rates of re-hospitalization. MicroRs, like miR-30d, are of particular interest in heart failure due to their regulatory role in gene expression and potential as biomarkers for diagnosing and predicting patient outcomes, especially in high-risk cases such as ACPE. We conducted a cohort study on patients diagnosed with ACPE in the Emergency Department (ED). The circulating levels of miR-30d were analyzed at the time of hospital admission and at one-month follow-up along with other biomarkers. We enrolled 24 ACPE patients and 10 control subjects. Median age was 80.8 years (interquartile range, IQR, 8.2) in ACPE cases, and 78.5 years (IQR 9.8) in controls with a male/female ratio of 2 and 0.66, respectively. In ACPE patients, median cardiac ejection fraction was 42.5%, creatinine 1.63 mg/dl (IQR 1.24), troponin 63.5 ng/dl (58), and NT-proBNP 4243.5 pg/mL (IQR 5846) at ED evaluation. Median concentration of miR30d was 0.81 in controls, and 3.67 and 7.28 in ACPE patients at enrollment time and one month later, respectively. Re-hospitalization occurred in 7 ACPE patients in the following 3 months, and in 9 during the following year. miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. When compared with the other biomarkers, none of them showed a better accuracy than miR-30d. Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. Larger, multicenter studies will be needed to confirm the validity of circulating miR-30d levels as a potential biomarker useful for risk prediction in ACPE patients and its utility in improving individualized patient care.

Redefining outcomes of ventricular arrhythmia for SGLT2 inhibitor medication in heart failure patients: a meta-analysis of randomized controlled trials

BackgroundSodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to lower the risk of re-hospitalization and cardiovascular mortality among heart failure (HF) patients. Nevertheless, the impact of these agents on ventricular arrhythmias (VAs) has not been thoroughly investigated. To assess the beneficial impact of SGLT2 inhibitors on VAs in patients at various stages of HF, a systematic review and meta-analysis of randomized controlled trials involving SGLT2 inhibitors in this patient population was performed.MethodsA comprehensive search of the PubMed, Embase, Ovid, ProQuest, Scopus, and Cochrane databases was performed for clinical trials published up to November 21, 2024. The primary outcomes of interest were incidences of VAs and sudden cardiac death (SCD) between the groups receiving SGLT2 inhibitors and the control drugs. For the outcomes observed in the populations of the included trials and in specific subgroups, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled and meta-analysed across the analyses.ResultsA total of 23 randomized trials (22 placebo-controlled trials and 1 active-controlled trial) involving 74,380 patients (37,372 receiving SGLT2 inhibitors and 37,008 in the control group) were included. The analysed SGLT2 inhibitors included canagliflozin, dapagliflozin, empagliflozin, bexagliflozin, sotagliflozin, and ertugliflozin. The participants were non-advanced HF patients, including at-risk for HF, pre-HF, and symptomatic HF, with follow-up duration ranging from 12 to 296 weeks. Compared with the control, treatment with SGLT2 inhibitors was associated with significantly reduced risk of VAs (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.74–0.98; P = 0.02) and SCD (RR 0.79, 95% CI 0.64–0.98; P = 0.03). Subgroup analyses indicated that longer follow-up (≥ 1 year) taking SGLT2 inhibitors can still reduce the risk of VAs (RR 0.79, 95% CI 0.65–0.96; P = 0.02) and SCD (RR 0.80, 95% CI 0.65–0.99; P = 0.04).ConclusionSGLT2 inhibitors have beneficial effects on lowering risks of VAs and SCD in patients with type 2 diabetes, cardiovascular diseases, heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and heart failure with mildly reduced ejection fraction (HFmrEF), with longer follow-up duration reinforcing these findings. However, future prospective trials are needed to verify the effects of SGLT2 inhibitors on VAs and SCD.Systematic review registrationPROSPERO (CRD42024601914)

Impact of Intensified Outpatient Follow-up on Rehospitalization after Transcatheter Aortic Valve Implantation: Results from the HOSPITAVI Trial.

Patients undergoing transcatheter aortic valve implantation (TAVI) are at increased risk of rehospitalization in the early period after discharge from TAVI. The HOSPITAVI study aimed to compare the impact of a standard vs. intensified outpatient follow-up on rehospitalization rates within 90 days after TAVI discharge. Patients were 1:1 randomized to either a standard or intensified outpatient follow-up after TAVI discharge. The primary endpoint was the 90-day hospital rehospitalization rate. In total, 300 patients were included: 150 patients were randomized to standard follow-up and 150 patients to intensified outpatient follow-up. The study population had a median age of 79 years, a median EuroSCORE II of 2.9%, and 72% were discharged the day after TAVI. Within 90 days after discharge, the mean number of all-cause hospital readmissions per patient was 0.44 vs. 0.35 (HR 0.8 [95%CI: 0.6-1.2], P=0.23) in the standard vs. intensified group, respectively. The mean number of cardiovascular (CV) readmissions per patient was 0.27 vs. 0.15 (HR 0.6 [95%CI: 0.4-1.0], P=0.04) in the standard vs. intensified group, respectively. This resulted in a mean number of CV readmission days per patient of 1.52 days vs. 0.49 days within the first 90 days in the standard vs. intensified group, respectively (P<0.05). Following TAVI discharge, there was no significant difference in all-cause rehospitalization rates using a standard vs. intensified outpatient follow-up approach. However, an intensified outpatient follow-up reduces the burden of early CV rehospitalization after TAVI discharge. (Rehospitalization after transcatheter aortic valve implantation [HOSPITAVI]; NCT05670041).

Effects of early ivabradine therapy in patients with acute heart failure: A meta-analysis and systematic review

BACKGROUND: Although ivabradine is the agent of choice for reducing heart rate, its use in acute heart failure patients remains unclear. OBJECTIVES: To evaluate the potential of in-hospital ivabradine administration in reducing heart rate, the risk of rehospitalization, mortality, and clinical profile in acute heart failure patients using a meta-analysis approach. METHODS: The study was designed as a meta-analysis conducted from August to September 2024. We selected several database sources for the search strategy, including PubMed, Google Scholar, ProQuest, British Medical Journal, and American Journal of Cardiology. Data on the outcomes of ivabradine treatment compared to standard therapy were collected to determine cumulative point estimates. For statistical analysis, we used the Mantel–Haenszel test for categorical data or inverse variance for continuous data. RESULTS: We included 11 articles in the study. Our findings indicated that, in comparison to the standard therapy group, the ivabradine group was associated with improvements in resting heart rate, a reduction in the risk of rehospitalization, a decrease in cardiovascular mortality, a reduction in all-cause mortality, a shorter length of stay, improvements in New York Heart Association (NYHA) classification, better Left Ventricular Ejection Fraction (LVEF), and improved B-type Natriuretic Peptide (BNP) / N-terminal pro b-type Natriuretic Peptide (NT-proBNP) levels. CONCLUSION: In conclusion, this study has revealed the beneficial effects of using ivabradine for the treatment of acute heart failure. Keywords: acute heart failure, beta blocker, heart rate, ivabradine, meta-analysis.

Prognostic value of TAPSE/RVSP ratio in patients with acute heart failure: a prospective observational cohort study

Abstract Background/Introduction The tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP) ratio, derived from echocardiography, has been proposed as a valid, non-invasive surrogate of the right ventricle-pulmonary artery coupling in heart failure (HF), demonstrating strong prognostic utilities in stable patients with chronic HF and preserved or reduced ejection fraction (EF). However, there are scarce data in patients with acute HF. Purpose The aim of the current study was to investigate the prognostic role of the TAPSE/RVSP ratio in adult patients hospitalised for acute HF in our Cardiology department. Methods This was a prospective observational cohort study of consecutive adult individuals who experienced an acute de novo HF event or had acute decompensated HF between August 2023 and June 2024. An independent investigator conducted a comprehensive transthoracic echocardiogram within the first 24 hours since admission and each patient was classified as having HF with reduced, mildly reduced or preserved EF according to the ESC guidelines. Moreover, the TAPSE/RVSP ratio was calculated according to the EACVI guidelines. All-cause mortality or HF re-hospitalisation was defined as the primary composite outcome and each patient was followed until the 20th of June or until the composite outcome occurred. TAPSE/RVSP ratio was divided in tertiles (≤0.30, 0.31-0.40, &amp;gt;0.40). Kaplan-Meier curves as well as univariate and multivariable cox regression analyses were used for data analysis and presentation. Results In total, 143 patients with acute HF (mean age 82 years, 58% female) were included in the study. Of those, 36% were diagnosed as having acute de novo HF. Half of total patients were classified as HF with preserved EF. Mean right ventricular diameter was 40 ± 8 mm and mean TAPSE was 15.4 ± 3.7 mm. During a median follow-up of 123 days, the composite outcome occurred in 36% of patients (n=52). By Kaplan-Meier analysis, individuals in the lowest tertile (TASPE/RVSP ratio ≤0.30) showed the lowest freedom from the composite outcome (Figure 1; p &amp;lt;0.0001, log-rank test). In multivariable regression analysis, TAPSE/RVSP ratio ≤0.30 was associated with a 14-fold risk of all-cause mortality or HF re-hospitalisation (Figure 2; adjusted hazard ratio: 14.7; 95% CI: 2.5, 85.3; p=0.002). Conclusions In patients hospitalised for acute HF, a statistically significant association between the TAPSE/RVSP ratio and the composite outcome was found. Those patients with TAPSE/RVSP ratio ≤0.30 had a 14-fold risk of all-cause mortality or HF re-hospitalisation. Kaplan-Meier curves Multivariable Cox regression analysis

P-1926. Once Is Enough, Two Is Too Much: Unraveling Predictors of COVID-19 Readmission among Previously Hospitalized Patients

Abstract Background While risk factors for COVID-19 hospitalization are well characterized, only a few studies investigated those associated with hospital re-admission after SARS-CoV-2 re-infections, since most are focused-on re-admission because of all-causes. Our aim was to identify co-morbidities and other risk factors associated with a second COVID-19 hospitalization. Study flowchart and timeline Methods Administrative database from the Lombardy Welfare Directorate was used to detect patients hospitalized for COVID-19 for a first time between 1st Feb 2020 to 31st Aug 2021. Information on demographic variables, hospital records and drug prescriptions were collected. The population comprised the re-hospitalized individuals, who were readmitted for COVID-19 at least 3 months after their initial hospital admission, likely because of a different SARS-CoV-2 infection and the non-re-hospitalized subjects. Follow-up observation lasted until the re-hospitalization, death or the end of study period. Adjusted hazard ratio (CI, 95%) was performed to assess the association between risk factors and re-hospitalization with a competing risk analysis. Multivariable analysis with competing risk, where death after 3 months is the competing risk for re-hospitalization due to COVID-19. Results From a total of 98,369 patients hospitalized for COVID-19, 25,776 (26.2%) died within three months and 610 (0.6%) were re-hospitalized for a likely new SARS-CoV-2 infection (Figure 1). Re-hospitalized patients were mostly male (61.3%) and were 72.2 years on average. The strongest risks for re-hospitalization in patients with a new episode of COVID-19 were kidney and liver diseases. However, a significant association for this risk was also observed for age, males, immune suppression, cerebro-vascular and cardio-vascular diseases, lung disease, diabetes, and some medications (Table 1). Conclusion We demonstrated that vulnerability due to multimorbidity and chronic conditions, such as kidney and liver disfunction, may diminish the ability to withstand physiological challenges, elevating the risk of re-hospitalization. The fact that the elderly, immune suppressed individuals, or those with chronic conditions may survive an initial hospitalization does not safeguard them from further admissions. We emphasized the importance of targeted interventions and heightened clinical vigilance for these high-risk patient populations. Disclosures All Authors: No reported disclosures

Left atrial function is a predictor of 90-day readmissions in patients with a first hospitalization for heart failure

Abstract Aim Heart failure (HF) readmissions are frequent and have important prognostic consequences. LACE index is a tool that estimates the risk of rehospitalization in different clinical scenarios, and has shown moderate discriminatory performance in HF. Our aim was to analyze the association of different clinical and echocardiographic parameters with the risk of 90-day readmissions and to address the performance of the LACE index in our cohort of patients with a first HF hospitalization. Methods Prospective cohort of patients with a first HF hospitalization in a tertiary care center between 2020 and 2022. Clinical, analytical and echocardiographic variables were collected at the time of admission. The primary outcome was 90-day readmissions for HF. Results The mean age of our cohort (n=178) was 73.4 (13) years and 69 (39%) were female. Mean LVEF was 43.8% (15). The prevalence of comorbidities was high: arterial hypertension 71%, diabetes 39%, obesity 29%, atrial fibrillation 25%, and chronic kidney disease 15%. Mean LACE index was 10 (2.8), which corresponds to a high risk of readmission. The incidence of 90-day readmission was 14%. Variables significantly associated with readmission were female sex, history of AF, right ventricular-arterial coupling index, left atrial stiffness, creatinine clearance, and systolic arterial pressure at discharge (Figure 1). A multivariable logistic regression analysis showed that atrial stiffness (OR 1.71; p=0.042) and creatinine clearance (OR 0.95; p=0.066) were the only two independent predictors of readmissions. A model comprising these 2 variables had an area under the ROC curve of 0.758 (95% CI: 0.65-0.84), and was statistically superior to LACE index (AUC 0.55; 95% CI: 0.48-0.63); p&amp;lt;0.005 (Figure 2). Conclusions In a cohort of patients with a first hospitalization for HF and high burden of comorbidities, a simple model which takes into account renal function and left atrial function showed good diagnostic yield for predicting 90-day readmissions. Logistic regression analysis ROC curves

Use of FGF-23 and sαKlotho for Risk Stratification in Patients with Acute Heart Failure

Background/Objectives: Soluble αKlotho (sαKlotho) and fibroblast growth factor 23 (FGF-23) are increased in acute heart failure (AHF). This study aimed to assess changes in serum sαKlotho and FGF-23 concentrations during an episode of AHF as well as the usefulness of both biomarkers for predicting long-term prognosis. Methods: The study included 104 consecutive patients hospitalized in t he intensive cardiac care unit due to AHF (mean age, 65.8 ± 14.6 years; mean ejection fraction, 31.4% ± 14). New-onset AHF was reported in 43.3% of the population. Blood samples were measured at entry and on discharge from hospital. The main clinical outcomes assessed in this study were all-cause mortality or rehospitalization due to HF during a 3-year follow-up. Results: At admission sαKlotho, FGF-23, and NT-pro BNP levels, compared with discharge, were significantly higher at p &lt; 0.001, p &lt; 0.001, and p &lt; 0.001 respectively. The 3-year Kaplan–Meier analysis, based on tertiles, revealed, for sαKlotho levels from Tertile 1 on admission and at discharge, a 2-fold higher rate of all-cause mortality or rehospitalization for HF compared with Tertile 3 (p = 0.006 and p = 0.028, respectively). One-third of patients showed an increase in FGF-23 and sαKlotho levels during hospitalization. Patients with the highest percentage increase in the levels of both biomarkers had an elevated risk of all-cause morality or hospitalization for HF (hazard ratio, 2.75; confidence interval, 1.19–6.35; p = 0.02). Conclusions: sαKlotho and FGF-23 levels are elevated during an episode of AHF. Low sαKlotho levels are associated with an increased risk of all-cause mortality or rehospitalization for HF. Increases in sαKlotho and FGF-23 values during hospitalization identify patients with poor prognosis.

Mid-Regional Pro-Adrenomedullin Is Associated with Adverse Cardiovascular Outcomes After Cardiac Surgery

Background: In the era of personalized medicine, tools for risk stratification after cardiovascular interventions are crucial to reduce mortality and morbidity, especially in the aging population. Biomarker-based approaches, in particular, have gained significant importance. Mid-regional pro-adrenomedullin (MR-proADM) represents an easily assessable biomarker that mirrors cardiac function and fibrosis. Therefore, we aimed to investigate the prognostic potential of MR-proADM in patients undergoing elective cardiac surgery. Methods: Patients undergoing elective cardiac bypass and/or valve surgery were prospectively enrolled between May 2013 and August 2018. The primary endpoint was the composite of hospitalization for heart failure (HHF) or cardiovascular (CV) mortality. Results: In total, 500 patients (146 female [29.2%]; median age 69.8 years (IQR 60.6–75.5 years) were included. Individuals were stratified into risk categories based on their MR-proADM values (Low Risk ≤ 0.63 nmol/L, Intermediate Risk &gt; 0.63 and ≤0.84, High Risk &gt; 0.84). A significant increase in 5-year event rates for HHF/CV mortality in patients in the high-risk category (Low Risk 8.6% vs. High Risk 37.7%, p &lt; 0.001) was observed. MR-pro ADM showed an independent association with HHF/ CV mortality (adjusted HR of 3.43, 95% CI 1.83–6.42; p &lt; 0.001 comparing the High-Risk group to the Low-Risk group). Conclusions: MR-pro ADM was found to be a strong and independent predictor for HHF/CV mortality in patients undergoing elective cardiac surgery. Considering a personalized diagnostic and prognostic work-up, a standardized preoperative evaluation of MR-proADM levels might help to identify patients at risk for major adverse events and early re-hospitalization.

A multivariable prediction model to stratify risk of 90-day rehospitalization among adults with ulcerative colitis

Abstract Background Individuals with ulcerative colitis (UC) are frequently re-hospitalized for persistent or recurrent severe disease flares. Accurate prediction of the risk of early re-hospitalization at the time of discharge could promote targeted outpatient interventions to reduce this risk. Methods We conducted a retrospective study in adults with UC admitted to The Ottawa Hospital between 2009 and 2016 for an acute UC-related indication. We ascertained candidate demographic, clinical, and health services predictors through medical records and administrative health databases. We derived and bootstrap validated a multivariable logistic regression model of 90-day UC-related re-hospitalization risk. We chose a probability cut point that maximized Youden’s index to differentiate high-risk from low-risk individuals and assessed model performance. Results Among 248 UC-related hospitalizations, there were 27 (10.9%) re-hospitalizations within 90 days of discharge. Our multivariable model identified gastroenterologist consultation within the prior year (adjusted odds ratio [aOR] 0.11, 95% confidence interval [CI], 0.04-0.39), male sex (aOR 3.27, 95% CI, 1.33-8.05), length of stay (OR 0.94, 95% CI, 0.88-1.01), and narcotic prescription at discharge (OR 1.96, 95% CI, 0.73-5.27) as significant predictors of 90-day re-hospitalization. The optimism-corrected c-statistic value was 0.78, and the goodness-of-fit test P-value was .09. The chosen probability cut point produced a sensitivity of 77.8%, specificity of 80.9%, positive predictive value (PPV) of 33.0%, and negative predictive value (NPV) of 96.7% in the derivation cohort. Conclusions A limited set of variables accessible at the point of hospital discharge can reasonably discriminate re-hospitalization risk among individuals with UC. Future studies are required to validate our findings.

Timing of acute decompensated heart failure in patients with heart failure and mildly reduced ejection fraction.

This study investigates the prognosis of acute decompensated heart failure (ADHF) on admission (i.e., primary ADHF) as compared to ADHF onset during course of hospitalization (i.e., secondary ADHF) in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). Limited data regarding the prognostic impact of the timing of onset of ADHF is available. Consecutive patients with HFmrEF and ADHF were retrospectively included at one institution from 2016 to 2022. Patients with primary ADHF were compared to patients with secondary ADHF with regard to the primary endpoint all-cause mortality at 30 months. Kaplan-Meier, uni- and multivariable Cox proportional regression analyses were applied for statistics. From a total of 484 patients hospitalized with HFmrEF and ADHF, 67.98% (n = 329) were admitted with primary ADHF. Patients with secondary ADHF had higher rates of concomitant acute myocardial infarction, alongside with a higher extend of coronary artery disease. The risk of all-cause mortality at 30months was not affected by the timing of ADHF (hazard ratio (HR) = 0.853; 95% confidence interval (CI) 0.653-1.115; p = 0.246). However, patients with primary ADHF were associated with a higher risk of HF-related rehospitalization at 30months (HR = 2.513; 95% CI 1.555-4.065; p = 0.001), which was still evident after multivariable adjustment (HR = 2.347; 95% CI 1.418-3.883; p = 0.001). The timing of onset of ADHF was not associated with long-term mortality in HFmrEF, however primary ADHF was associated with a higher risk of HF-related rehospitalization.

Predictors of COVID-19 Readmission Among Patients Previously Hospitalized for SARS-CoV-2.

Predictors of coronavirus disease 2019 (COVID-19)-related rehospitalization remain underexplored. This study aims to identify the main risk factors associated with rehospitalizations due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections among residents of Lombardy, northern Italy. A retrospective observational study was conducted using two linked administrative databases covering demographic data, comorbidities, hospital records, and COVID-19 data of Lombardy residents. The study population included patients hospitalized for COVID-19 between February 2020 and August 2021. Rehospitalization was defined as a second COVID-19-related hospitalization occurring at least 90days after the first admission. The Fine-Gray subdistribution hazard model was used to identify risk factors, accounting for death as a competing risk. Out of 98,369 patients hospitalized for COVID-19 between February 1, 2020 and August 31, 2021, 72,593 were alive 90days after admission and 610 of these (0.8%) were rehospitalized. A higher rehospitalization risk was observed in older male patients with multiple comorbidities. Renal failure, liver disease, and use of diuretics were significantly associated with rehospitalization risk, while female biological sex and the use of lipid-lowering drugs were associated with a lower risk. This is the first study conducted on regional administrative databases to investigate COVID-19 rehospitalizations. Through the availability of a huge cohort, it provides a groundwork for optimizing care for individuals at higher risk for COVID-19-related rehospitalizations. It underlines the need for patient-management approaches that extend beyond the initial recovery. This stresses the importance of ongoing monitoring and personalized interventions for those at heightened risk not only of SARS-CoV-2 reinfection but also related rehospitalizations.

Long-Term Clinical Impact of Paravalvular Leak Following Transcatheter Aortic Valve Implantation.

Background: Paravalvular leak (PVL) was initially recognized as one of the most common complications after transcatheter aortic valve implantation (TAVI) and has been linked to adverse clinical outcomes, including mortality. This study aims to assess the long-term clinical effects of PVL in patients undergoing TAVI with the latest generation of transcatheter aortic valves, as part of the national observational prospective multicenter study OBSERVANT II. Methods: OBSERVANT II included all consecutive patients with severe aortic stenosis who underwent TAVI across 28 Italian centers from December 2016 to September 2018. A total of 2125 patients were included in this analysis and stratified according to the presence of moderate-to-severe PVL (significant PVL, n = 155) versus no/trace-to-mild PVL (no significant PVL, n = 1970). The primary endpoint was 5-year major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, myocardial infarction, and coronary revascularization. Five-year all cause death and re-hospitalization for heart failure (HF) were the secondary endpoints. Results: In our cohort, the incidence of moderate-to-severe PVL was 7%. Age, aortic anulus perimeter, and self-expandable valves were determinants of PVL. The risk of MACCE, all-cause death, and re-hospitalization for HF at the 5-year follow-up were not different between the study groups [HR = 1.07 (95% CI: 0.85-1.34) p = 0.571; HR = 1.10 (95% CI: 0.87-1.39) p = 0.435; HR = 1.20 (95% CI: 0.88-1.62) p = 0.245, respectively]. Conclusions: In this analysis of the OBSERVANT II study, moderate/severe PVL was not associated with a higher incidence of MACCE and re-hospitalization for heart failure at the 5-year follow-up.

Prognostic Implications of Sex in Patients With Heart Failure With Mildly Reduced Ejection Fraction: Results From a Large-Scaled Registry.

The study investigates the prognostic impact of sex and sex-related differences in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). More data regarding the characterization of patients and their outcomes in the presence of HFmrEF are needed. Consecutive patients hospitalized with HFmrEF (ie, left ventricular ejection fraction 41%-49% and signs or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Female patients were compared with male patients with regard to the primary end point of all-cause mortality at 30 months (median follow-up). Statistical analyses comprised Kaplan-Meier, multivariable Cox proportional regression analyses and propensity score matching. From a total of 2184 patients hospitalized with HFmrEF, 64.6% were male. Female patients with HFmrEF were older than male patients (median age 78 versus 73 years; P=0.001) and had lower rates of ischemic cardiomyopathy (46.6% versus 63.6%; P=0.001). Within the entire study cohort, sex was not associated with the risk of all-cause mortality (hazard ratio [HR], 0.931 [95% CI, 0.797-1.088]; P=0.372). However, male sex was associated with a lower risk of HF-related rehospitalization at 30 months (HR, 0.761 [95% CI, 0.600-0.966]; P=0.026), which was confirmed after multivariable adjustment (HR, 0.759 [95% CI, 0.592-0.973]; P=0.029) and propensity score matching (HR, 0.722 [95% CI, 0.539-0.967]; P=0.029). Although almost two thirds of patients hospitalized with HFmrEF were male, sex was no predictor for the risk of all-cause mortality at 30 months. However, female sex was associated with a higher risk of HF-related rehospitalization. URL: https://clinicaltrials.gov; Unique identifier: NCT05603390.