US Nationwide Readmissions Database Research Articles

Impact of Cirrhosis Etiology on the Risk for Venous Thromboembolism.

Cirrhosis is associated with an increased risk for both bleeding and venous thromboembolic (VTE) complications. The data regarding the impact of etiology of cirrhosis on VTE risk is poorly understood. In this retrospective observational analysis of the US Nationwide readmissions database 2019, we identified hospitalized patients who had cirrhosis from alcohol, viral, or nonalcoholic steatohepatitis (NASH) etiologies. We identified patients who had acute VTE, chronic/history of VTE, and portal venous thrombosis (PVT). Overall VTE risk was defined as the composite of acute and chronic VTE or PVT. The impact of etiology of cirrhosis on the crude and risk adjusted rates of VTE and PVT was studied. Of 432,383 patients with cirrhosis, 41.4% patients had NASH-cirrhosis, 39.7% had alcohol-related cirrhosis, and 18.9% had viral cirrhosis. The overall VTE rate was highest in patients with NASH cirrhosis (10.8%) followed by viral cirrhosis (9.7%) and alcohol-related cirrhosis (7.5%; P < 0.001). Similar results were observed for acute and chronic VTE. After risk adjustment, patients with NASH (OR 1.48 95% CI 1.42-1.54) and viral cirrhosis (OR 1.22 95% CI 1.17-1.29) had significantly higher overall VTE risk compared with alcohol-related cirrhosis. When separately evaluated, the adjusted risk for acute and chronic VTE was similar between patients with alcohol-related and viral cirrhosis but higher with NASH cirrhosis. PVT rate was highest with viral cirrhosis (4.3%) followed by NASH (2.8%) and alcohol-related cirrhosis (2.4%; P < 0.001). The adjusted risk of PVT was higher with viral (OR 1.61 95% CI 1.50-1.72) and NASH cirrhosis (OR 1.41 95% CI 1.31-1.52). NASH cirrhosis was associated with a higher VTE risk compared with alcohol-related and viral etiologies. As NASH cirrhosis increases in prevalence as the major etiology of cirrhosis, it is important to understand the increased VTE risk associated with this condition to improve management strategies and patient outcomes.

Characteristics and Outcomes of Hospitalized Patients With Heart Failure and Sarcoidosis: A Propensity-Matched Analysis of the Nationwide Readmissions Database 2010-2019

BackgroundSarcoidosis is associated with a poor prognosis. There is a lack of data examining the outcomes and readmission rates of sarcoidosis patients with heart failure (SwHF) and without heart failure (SwoHF). We aimed to compare the impact of non-ischemic heart failure on outcomes and readmissions in these two groups. MethodsThe US Nationwide Readmission Database was queried from 2010 to 2019 for SwHF and SwoHF patients identified using the International Classification of Diseases, 9th and 10th Editions. Those with ischemic heart disease were excluded, and both cohorts were propensity matched for age, gender, and Charlson Comorbidity Index (CCI). Clinical characteristics, length of stay, adjusted healthcare-associated costs, 90-day readmission and mortality were analyzed. ResultsWe identified 97,961 hospitalized patients (median age 63 years, 37.9% male) with a diagnosis of sarcoidosis (35.9% SwHF vs 64.1% SwoHF). On index admission, heart failure patients had higher prevalences of atrioventricular block (3.3% vs 1.4%, P < .0001), ventricular tachycardia (6.5% vs 1.3%, P < .0001), ventricular fibrillation (0.4% vs 0.1%, P < .0001) and atrial fibrillation (22.1% vs 7.5%, P < .0001). SwHF patients were more likely to be readmitted (hazard ratio 1.28, P < .0001), had higher length of hospital stay (5 vs 4 days, P < .0001), adjusted healthcare-associated costs ($9,667.0 vs $9,087.1, P < .0001) and mortality rates on readmission (5.1% vs 3.8%, P < .0001). Predictors of mortality included heart failure, increasing age, male sex, higher CCI, and liver disease. ConclusionSwHF is associated with higher rates of arrhythmia at index admission, as well as greater hospital cost, readmission and mortality rates compared to those without heart failure.

The prognostic association of atrial fibrillation on heart failure hospitalizations after acute myocardial infarction

Abstract Aims The association of atrial fibrillation (AF) with heart failure (HF) specific hospitalizations after acute myocardial infarction (AMI) is unclear. We aim to study the association of AF and 6-month HF hospitalization after an AMI in a large American cohort. Methods and Results Adult survivors of a AMI hospitalization without cardiogenic shock were identified from the 2019 US Nationwide Readmissions Database. The unadjusted association of AF (pre-existing and denovo) with baseline characteristics and primary outcome of rate of 6-month HF admission, and secondary outcomes of fatal HF admission, composite of HF peri-AMI or a 6-month HF admission, and a composite of 6-month HF or death during a non−HF-related admission was evaluated using chi square tests or t-tests, and independent associations of AF on outcomes were evaluated using multivariable logistic regression. Cox proportional hazards models were used to identify the association of AF on cumulative incidence risk on HF readmission. Of 262,390 AMI survivors, AF was present in 18.0%. By 6-months, HF hospitalization occurred in 5.4% of all patients. AF was associated with a higher adjusted risk for 6-month HF admission (OR 1.42, 95% CI: 1.34-1.50). In the adjusted time-to-event analysis, AF was associated with a higher risk for 6-month HF readmission (HR 1.39, 95% CI 1.31-1.46, P&amp;lt;0.001). AF was associated with a higher risk for fatal HF and the composite outcomes. Conclusions AF was present in 1 in 6 AMI survivors without cardiogenic shock and AF was associated with a higher risk of HF hospitalization in the subsequent 6-month period.Cumulative Incidence CurvesOutcomes Table

Causes and Predictors of 30-Day Readmission in Patients With COVID-19 and ST-Segment-Elevation Myocardial Infarction in the United States: A Nationwide Readmission Database Analysis.

Background Rates, causes, and predictors of readmission in patients with ST-segment-elevation myocardial infarction (STEMI) during COVID-19 pandemic are unknown. Methods and Results All hospitalizations for STEMI were selected from the US Nationwide Readmissions Database 2020 and were stratified by the presence of COVID-19. Primary outcome was 30-day readmission. Multivariable hierarchical generalized logistic regression analysis was performed to compare 30-day readmission between patients with STEMI with and without COVID-19 and to identify the predictors of 30-day readmissions in patients with STEMI and COVID-19. The rate of 30-day all-cause readmission was 11.4% in patients with STEMI who had COVID-19 and 10.6% in those without COVID-19, with the adjusted odds ratio (OR) not being significantly different between the two groups (OR, 0.88 [95% CI, 0.73-1.07], P=0.200). Of all 30-day readmissions in patients with STEMI and COVID-19, 41% were for cardiac causes. Among the cardiac causes, 56% were secondary to acute coronary syndrome, while among the noncardiac causes, infections were the most prevalent. Among the causes of 30-day readmissions, infectious causes were significantly higher for patients with STEMI who had COVID-19 compared with those without COVID-19 (29.9% versus 11.3%, P=0.001). In a multivariable model, congestive heart failure, chronic kidney disease, low median household income, and length of stay ≥5 days were found to be associated with an increased risk of 30-day readmission. Conclusions Post-STEMI, 30-day readmission rates were similar between patients with and without COVID-19. Cardiac causes were the most common causes for 30-day readmissions, and infections were the most prevalent noncardiac causes.

Sex differences in clinical characteristics and outcomes associated with alcoholic hepatitis.

Alcohol-associated liver disease is increasing among females with an earlier onset and more severe disease at lower levels of exposure. However, there is paucity of literature regarding sex differences related to alcoholic hepatitis. Hospitalized patients with alcoholic hepatitis were selected from the US Nationwide readmissions database 2019. In this cohort, we evaluated sex differences in baseline comorbidities, alcoholic hepatitis related complications and mortality. A subset of patients with alcoholic hepatitis who were hospitalized between January and June 2019 were identified to study sex differences in 6 month readmission rate, mortality during readmission, and composite of mortality during index hospitalization or readmission. Among 112 790 patients with alcoholic hepatitis, 33.3% were female. Female patients were younger [48 (38-57) vs. 49 (39-58) years; both P < 0.001] but had higher rates of important medical and mental-health related comorbidities. Compared with males, females had higher rates of hepatic encephalopathy (11.5% vs. 10.1; P < 0.001), ascites (27.9% vs. 22.5%; P < 0.001), portal hypertension (18.5% vs. 16.4%; P < 0.001), cirrhosis (37.3% vs. 31.9%; P < 0.001), weight loss (19.0% vs. 14.5%; P < 0.001), hepatorenal syndrome (4.4% vs. 3.8%; P < 0.001), spontaneous bacterial peritonitis (1.9% vs. 1.7%; P = 0.026), sepsis (11.1% vs. 9.5%; P < 0.001), and blood transfusion (12.9% vs. 8.7%; P < 0.001). Females had a similar in-hospital mortality rate (4.3%) compared to males (4.1%; P = 0.202; adjusted odds ratio (OR) 1.02, 95% CI (cardiac index) 0.89-1.15; P = 0.994). In the subset of patients ( N = 58 688), females had a higher 6-month readmission rate (48.9% vs. 44.9%; adjusted OR 1.12 (1.06-1.18); P < 0.001), mortality during readmission (4.4% vs. 3.2%; OR 1.23 (1.08-1.40); P < 0.01), and composite of mortality during index hospitalization or readmission (8.7% vs. 7.2%; OR 1.15 (1.04-1.27); P < 0.01). Compared to their male counterparts, females with alcoholic hepatitis were generally younger but had higher rates of comorbidities, alcoholic hepatitis related complications, rehospitalizations and associated mortality. The greater risks of alcohol-associated liver dysfunction in females indicate the need for more aggressive management.

30-Day Cardiovascular Readmissions Following Discharge With COVID-19: A US Nationwide Readmission Database Analysis From the Pandemic Year 2020

BackgroundCOVID-19 is known to be associated with a myriad of cardiovascular (CV) complications during acute illness, but the rates of readmissions for CV complications after COVID-19 infection are less well established. MethodsThe US Nationwide Readmission Database was utilized to identify COVID-19 admissions that occurred in the period from April 1st to November 30th, 2020, using International Classification of Diseases, 10th edition, Clinical Modification administrative claims. ResultsA total of 521,351 admissions for COVID-19 were identified. The all-cause 30-day readmission rate was 11.6% (n = 60,262). The incidence of CV-related readmissions was 5.1% (n = 26,725), accounting for 44.3% of all-cause 30-day readmissions. Both CV-related and non-CV-related readmissions occurred at a median of 7 days. Patients readmitted with CV causes had a higher comorbidity burden, with a median Charlson comorbidity score of 6. The most common CV cause of readmission was acute heart failure (8.5%), followed by acute myocardial infarction (5.2%). Venous thromboembolism and stroke during 30-day readmission occurred at rates of 4.6% and 3.6%, respectively. Stress cardiomyopathy and acute myocarditis were less frequent, with incidences of 0.1% and 0.2%, respectively. CV-related readmissions were associated with higher mortality, compared with non-CV-related readmissions (16.5% vs 7.5%, P < 0.01). Each 30-day CV-related readmission was associated with greater cost of care than each non-CV-related readmission ($13,803 vs $10,310, P < 0.01). ConclusionsAmong survivors of index COVID-19 admission, 44.7% of all 30-day readmissions were attributed to CV causes. Acute heart failure remains the most common cause of readmission after COVID-19, followed closely by acute myocardial infarction. CV causes of readmissions remain a significant source of mortality, morbidity, and resource utilization.

Impact of chronic obstructive pulmonary disease on heart failure hospitalizations after an acute myocardial infarction.

The presence of chronic obstructive pulmonary disease (COPD) can impact the management of acute myocardial infarction (AMI) and is associated with higher mortality. Few studies addressed COPD impact on heart failure hospitalisations (HFHs) in AMI survivors. Adult survivors of an AMI between January and June 2014 were identified from the US Nationwide Readmissions Database. The impact of COPD on HFH within 6 months, fatal HFH and the composite of in-hospital HF or 6-month HFH was studied. Of 237,549 AMI survivors, patients with COPD (17.5%) were older, more likely female, had a higher prevalence of cardiac comorbidities and a lower coronary revascularization rate. In-hospital HF was more frequent in patients with COPD (47.0% vs. 25.4%; p < 0.001). HFH within 6 months occured in 12,934 (5.4%) patients, at a 114% higher rate in patients with COPD (9.4% vs. 4.6%, OR = 2.14, 95% CI : 2.01-2.29; p < 0.001), which was attenuated to a 39% higher adjusted risk (OR = 1.39, 95% CI: 1.30-1.49). Findings were consistent across subgroups of age, AMI type, and major HF risk factors. Mortality during a HFH (5.7% vs. 4.2%, p < 0.001) and the rate of the composite HF outcome (49.0% vs. 26.9%, p < 0.001) were significantly higher in patients with COPD. COPD was present in 1 of 6 AMI survivors and was associated with worse HF related outcomes. The increased HFH rate in COPD patients was consistent across several clinically relevant subgroups and these findings highlight the need for optimal in-hospital and post-discharge management of these higher-risk patients.

Abstract 12834: Hospital Variation in Implantation of Permanent Pacemaker After Transcatheter Aortic Valve Implantation: An Insight From the US Nationwide Readmission Database

Background: Pacemaker implantation (PPM) remains the most common complication after TAVI. However, the relationship between hospital volume of TAVI discharge and PPM implantation remains unknown. Methods and Results: The purpose of this study was to evaluate the association between annual TAVI discharge volumes with 30-day incidence of PPM implantation. We utilized the most recent available 2018 US Nationwide Readmission Database. International Classification of Diseases ICD-10 codes were used to identify all hospitalizations. We categorized hospitals performing &lt;100 cases per year as low-volume; 100 to 200 as medium-volume and &gt;200 high-volume facilities. A total of 34,740 non-weighted TAVI hospitalizations were included in this analysis. Of the included cases, 37.5% (13,024) were performed in low volume centers, whereas 31.3% (10,862) and 31.2% (10,854) cases were performed in medium and high-volume centers. The overall 30-day rate of PPM Implantations was 19.5% (6,771). On adjusted analysis there was no difference between high (OR 1.01, 95% CI 0.95-1.08) and medium volume (OR 1.02, 95% CI 0.95-1.09) centers when compared to low volume centers respectively. Moreover, cumulative incidence curves showed similar rates of readmission for PPM implantations (Figure 1: P log rank 0.20). Conclusions: PPM implantation rates remain high post TAVI. Higher volume of TAVI discharge does not result in fewer PPM implantations. Further studies and interventions are required to reduce PPM implantation after TAVI.

Abstract 14873: Analysis of Heart Failure Re-Admissions and In-Hospital Outcomes in Patients With Takotsubo Syndrome

Background: Takotsubo Syndrome (TTS) is characterized by transient reduction in left ventricular function with in the absence of obstructive coronary artery disease. Clinical presentation often mimics acute myocardial infarction (AMI). Patients with TTS have comparable long-term mortality with AMI patients. However, data on the burden of heart failure (HF) readmissions in patients with TTS are scarce. Methods: This retrospective analysis utilized the US Nationwide Readmission Database for the years 2012-2019 to identify hospitalizations for TTS or AMI. The primary outcome of interest was 6-month readmission due to HF. Secondary outcomes included in-hospital mortality. Results: There were 30,926 hospitalizations with TTS and 2,535,025 hospitalizations with AMI. The proportion of women was 90% among TTS patients and 37.7% among AMI patients (p&lt;0.001). Overall comorbidities were similar between the two groups, but in-hospital mortality during index admission was higher in the AMI arm (6.5% vs 1.5% in TTS, p &lt;0.01) accompanied with increased in-hospital complications. All-cause readmission rates were lower among TTS than among AMI patients (21.9% vs. 29.4%; p &lt;0.01). HF readmissions were also lower among TTS than AMI patients (3.7% vs. 6.7%; p &lt;0.01). After propensity matching, all-cause readmission rate remained lower among TTS than among AMI patients (21.9% vs. 27.9%; p &lt;0.01). HF hospital readmissions rates were also lower among TTS patients (3.7% vs 5.7%; p &lt;0.01). Independent predictors of HF readmission in TTS population included comorbidities such as diabetes mellitus, atrial fibrillation, chronic kidney disease, peripheral vascular disease, and chronic pulmonary disease. Conclusion A substantial proportion of patients (&gt;20%) with TTS suffer a hospital readmission within 6 months, although less than 5% are readmitted with HF. Compared with AMI, all-cause and HF readmission rates are lower in TTS patients.

Thirty-day readmission rate of same-day discharge protocol after left atrial appendage occlusion: A propensity score-matched analysis from the National Readmission Database.

Given the reduction in periprocedural complication rates, same-day discharge (SDD) after percutaneous left atrial appendage closure (LAAC) could be beneficial. To date, little data exist comparing the standard overnight stay (ONS) vs SDD after LAAC. The purpose of this study was to investigate the safety and efficacy of SDD compared with ONS. A retrospective cohort study of LAAC procedures performed in the United States from 2015 to 2019 was conducted using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission after discharge in patients who underwent LAAC, and a secondary outcome was requiring total health care cost. A 1:1 propensity score matching was conducted for adjustment. Multivariate Cox proportional hazards regression was also performed to estimate the hazard ratio for all-cause readmission within 30 days of LAAC. Of 48,953 patients (mean age 76.0 ± 7.9 years), 972 patients (1.99%) were discharged on the same day after LAAC (SDD group) and the remaining 47,981 patients stayed at least 1 night (ONS group). A propensity score-matched analysis generated 961 matched pairs in each group. The 30-day readmission rate after discharge was similar between the groups (SDD vs ONS: 8.5% vs 9.8%; P = .31; hazard ratio 1.13; 95% confidence interval 0.78-1.63; P = .53). The total required health care cost was significantly lower in the SDD group ($23,720 [$18,075-$29,416] vs $25,877 [$19,906-$32,748]; P < .01). Gastrointestinal bleeding was the major cause for readmission (SDD vs ONS: 14.7% vs 15.1%; P = .95), but stroke and pericardial effusion were rare. In patients without procedure-related complications, SDD is a safe and cost-effective protocol.

Hospital procedural volume and clinical outcomes for transcatheter aortic valve replacement – US nationwide readmission database, 2016–2019

Abstract Background The number of hospitals offering transcatheter aortic valve replacement (TAVR) programs has increased exponentially in the United States over past several years. Multiple prior studies indicate relationship between hospital volume and clinical outcomes for various cardiac procedures. Purpose The association between the hospital procedural volume and clinical outcomes for TAVR is yet poorly understood. In this study, we aim to examine the in-hospital outcomes after TAVR stratified by hospital volume within a nationally representative, large database. Methods The National Readmission Database (NRD) 2016–2019 was used to identify hospitals with established TAVR programs (performing ≥20 TAVRs/year). Based on annualized procedural volume of transfemoral TAVR, hospitals were stratified into tertiles of low, medium, and high volume TAVR centers. Rates of adverse in-hospital events (death, cardiac arrest, stroke, vascular complications, and permanent pacemaker), 30-day mortality, and 30-day readmission rates were examined. Multivariate logistic regression analysis was performed to compare overall outcomes following TAVR in low-, medium-, and high-volume centers; adjusted for baseline characteristics and comorbidity burden. Results Of 71 million discharge records reviewed, a total of 232,581 patients underwent transfemoral TAVR between 2016–2019. Of all the TAVR cases, 77,183 (33.2%), 75,987 (32.7%), and 79,411 (34.1%) were performed at low-, medium-, and high-volume hospitals respectively. The median number of annual TAVR procedures was 91, 229, and 456 in low-, medium-, and high-volume centers respectively. Adjusted in-hospital mortality was significantly higher in low-volume (OR: 1.40, 95% CI: 1.21–1.62, p&amp;lt;0.01) and medium-volume (OR: 1.29, 95% CI: 1.11–1.50, p&amp;lt;0.01) hospitals compared with high-volume centers. Similarly, adjusted 30-day mortality (OR: 1.45, 95% CI: 1.27–1.66, p&amp;lt;0.01), 30-day readmission rates (OR: 1.11, 95% CI: 1.05–1.18, p&amp;lt;0.01), and in-hospital cardiac arrest (OR: 1.20, 95% CI: 1.08–1.33, p&amp;lt;0.01) were significantly higher for centers in the lowest-volume tertile compared with those in the highest-volume tertile. There were no significant differences in hospital length of stay (mean, 4.3±6.5 days), in-hospital stroke, acute kidney injury, vascular complications, need for permanent pacemaker, or mechanical circulatory support post-TAVR between the three groups. Conclusion In the United States, an inverse volume-mortality relationship was observed for transfemoral TAVR procedures from 2016 through 2019. Mortality and readmission rates at 30 days post-TAVR were significantly higher at low-volume hospitals compared with high-volume hospitals. Further research focusing at establishing protocols and standardized training programs may help mitigate the discrepancy in TAVR outcomes amongst hospitals with discrepant procedural volume. Funding Acknowledgement Type of funding sources: None.

S1319 Etiologies for In-Hospital Mortality in Patients With Compensated and Decompensated Hepatic Cirrhosis

Introduction: Cirrhosis is the end-stage of chronic liver disease and is generally associated with poor outcome, increased hospitalizations, and mortality. The occurrence of decompensated cirrhosis further markedly increases mortality. Knowledge regarding the causes of mortality and hospitalization can help risk stratify hospitalized patients with cirrhosis. Methods: Using the US Nationwide readmissions database 2014, we identified hospitalized patients who had cirrhosis and died during their hospitalization. In this cohort, we identified rates of cirrhotic and non-cirrhotic complications and etiologies for hospitalization. Causes of death were identified by the primary discharge diagnosis. Decompensated cirrhosis was defined as the presence of hepatic encephalopathy (HE), ascites, jaundice, variceal bleeding (VB), spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), or hepatocellular carcinoma (HCC). Appropriate ICD-9 codes were used to identify all diagnoses and procedures. Results: We studied 291,368 patients with cirrhosis of whom 38,394 patients (13.2%) died in-hospital. Around 19% of patients who had decompensation (53% of all patients) and 6.7% of patients who had compensated cirrhosis (47%) died during a hospitalization. Decompensated cirrhosis was present in 76.1% (N=29,212) of patients with mortality. Ascites was present in 50.3%, HE in 32.1%, VB in 23.2%, HRS in 19.4%, SBP in 9.1%, jaundice in 5.6% and HCC in 8.7%. In the overall cohort, the most common causes of death were sepsis (31.2%) followed by decompensated cirrhosis (13.6%), viral hepatitis (3.9%), respiratory failure (3.8%), and gastrointestinal bleeding (non-variceal) (3.8%). In patients with compensated cirrhosis, major causes of death were sepsis (33.8%), respiratory failure (6.3%), stroke (5.1%), congestive heart failure (3.4%), and traumatic intracranial injury (3.3%). When decompensation was present, major causes of death were sepsis (30.4%), decompensated cirrhosis (17.9%), gastrointestinal bleeding (4.6%), viral hepatitis (4.5%), and respiratory failure (3.1%). Conclusion: In the US, 1 in 7 hospitalized patients with cirrhosis, 1 in 5 with decompensated cirrhosis, and 1 in 14 with compensated cirrhosis had in-hospital mortality. Sepsis is the most common cause of death (1/3rd) in cirrhotic patients, in both compensated and decompensated cirrhosis. These data can help risk stratify and improve management strategies of hospitalized patients with cirrhosis.

TCT-410 Hospital Procedural Volume and Clinical Outcomes for Transcatheter Mitral Valve Repair – US Nationwide Readmission Database, 2014-2019

TCT-410 Hospital Procedural Volume and Clinical Outcomes for Transcatheter Mitral Valve Repair – US Nationwide Readmission Database, 2014-2019

All-cause unplanned readmissions in the United States: insights from the Nationwide Readmission Database.

There are few studies looking into adult, all-cause and age-group-specific unplanned readmissions. The predictors of such unplanned readmissions for all inpatient encounters remain obscure. To describe the incidence and factors associated with unplanned readmissions in all inpatient encounters in the United States. The US Nationwide Readmission Database (NRD) is a representative sample of hospitalisations in the United States (from approximately 28 states) accounting for approximately 60% of the US population. All inpatient encounters during January-November 2017 in the NRD were evaluated for the rates, predictors and costs of unplanned 30 days readmissions for age groups 18-44 years, 45-64 years, 65-75 years and ≥75 years. Elective readmissions and those patients who died on their index hospitalisations were excluded. Weighted analysis was performed to obtain nationally representative data. We identified 28 942 224 inpatient encounters with a total of 3 051 189 (10.5%) unplanned readmissions within 30 days. The age groups 18-44 years, 45-64 years, 65-74 years and ≥75 years had 7.0%, 12.0%, 11.7% and 12.3% readmissions respectively. Female gender, private insurance and elective admissions were negative predictors for readmissions. For the group aged 18-44 years, schizophrenia and diabetes mellitus complications were the most frequent primary diagnosis for readmissions, while in all older age groups septicaemia and heart failure were the most frequent primary diagnosis for readmissions. Thirty-day unplanned readmissions are common in patients over age 45 years, leading to significant morbidity. Effective strategies for reducing unplanned readmission may help to improve quality of care, outcomes and higher value care.

Trends, Predictors, and Outcomes of 30-Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database.

BACKGROUNDData on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established.METHODS AND RESULTSThe Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period (P trend=0.06); however, all‐cause readmission rates decreased significantly (P trend=0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P<0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non‐HF readmission.CONCLUSIONSDuring the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.

The 30-day readmission rate of same-day discharge protocol following catheter ablation for atrial fibrillation: a propensity score-matched analysis from National Readmission Database.

The effectiveness and safety of same-day discharge (SDD) for catheter ablation (CA) for atrial fibrillation (AF) has not been fully elucidated using a large nationwide database. This study aimed to evaluate the all-cause readmission rates within 30-days among patients receiving CA for AF with an SDD protocol compared with a conventional overnight stay (ONS). We performed a retrospective cohort study using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission following discharge in patients receiving CA and a secondary outcome was requiring total healthcare cost. A 1 : 3 propensity score matching was conducted to compare the safety and efficacy within both SDD and ONS group. Among 30 776 patients [mean 67.2 ± 11.4 years, 12 590 female (41.5%)] who received CA from 2016 through 2018, 440 (1.42%) patients were discharged on the same-day following CA (SDD group), and the remaining 30 336 patients stayed at least one night in the hospital (ONS group). A propensity score analysis generated 1751 matched pairs (440 in the SDD group; 1311 in the ONS group). The 30-day readmission following discharge was not significantly higher in the SDD group than the ONS group (SDD vs. ONS: 12.7% vs. 9.7%; hazard ratio: 1.17, 95% confidence interval: 0.76-1.81, P = 0.47). Healthcare cost was significantly higher in the ONS group ($25 237 ± 14 036 vs. $30 749 ± 16 383; P < 0.01). In this nationwide database study, there was no significant difference in the all-cause 30-day readmission following SDD for CA compared with ONS.

Influence of diabetes mellitus interactions with cardiovascular risk factors on post-myocardial infarction heart failure hospitalizations

ObjectiveThere is a paucity of information regarding how cardiovascular risk factors (RF) modulate the impact of diabetes mellitus (DM) on the heart failure hospitalization (HFH) risk following an acute myocardial infarction (AMI). MethodsAdult survivors of an AMI were retrospectively identified from the 2014 US Nationwide Readmissions Database. The impact of DM on the risk for a 6-month HFH was studied in subgroups of RFs using multivariable logistic regression to adjust for baseline risk differences. Individual interactions of DM with RFs were tested. ResultsOf 237,549 AMI survivors, 37.2% patients had DM. Primary outcome occurred in 12,934 patients (5.4%), at a 106% higher rate in DM patients (7.9% vs 4.0%, p < 0.001), which was attenuated to a 45% higher adjusted risk. Higher HFH risk in DM patients was consistent across subgroups and significant interactions were present between DM and other RFs. The increased HFH risk with DM was more pronounced in patients without certain HF RFs compared with those with these RFs [age < 65: OR for DM 1.84 (1.58–2.13) vs age ≥ 65: OR 1.34 (1.24–1.45); HF absent during index AMI: OR for DM 1.87 (1.66–2.10) vs HF present: OR 1.24 (1.14–1.34); atrial fibrillation absent: OR for DM 1.57 (1.46–1.68) vs present: OR 1.19 (1.06–1.33); Pinteraction < 0.001 for all]. Similar results were noted for hypertension and chronic kidney disease. ConclusionsAMI survivors with DM had a higher risk of 6-month HFHs. The impact of DM on the increased HFH risk was more pronounced in patients without certain RFs suggesting that more aggressive preventive strategies related to DM and HF are needed in these subgroups to prevent or delay the onset of HFHs.

The 30-day readmission of same-day discharge following pulmonary vein isolation for atrial fibrillation: a propensity score-matched analysis from National Readmission Database

Abstract Introduction The complication rate following pulmonary vein isolation (PVI) for atrial fibrillation (AF) has improved in recent decades with the increasing number of PVI worldwide. The effectiveness and safety of same-day discharge for PVI has not been elucidated well using a large nationwide database. Purpose The aim of our study was to evaluate the readmission rates within 30-days among patients receiving PVI for AF with the same-day discharge compared with the usual overnight observation protocol. Methods We performed a retrospective cohort study using the US Nationwide Readmission Database. Patients were divided into the two groups: the same-day discharge group and the overnight observation group (those who stayed at least one night following PVI). The primary outcome was an all-cause 30-day readmission rate following discharge in patients receiving PVI and a secondary outcome of total healthcare cost. A 1:3 propensity score matching was used to compare the safety within both protocols. Patients with peri-procedural complications such as pericardial, vascular, bleeding requiring transfusion, were excluded from the analysis. Result Among 30,776 patients (mean 67.2±11.4 years, 18,004 male (58.5%)) who received PVI from 2016 through 2018, 440 (1.42%) patients were discharged the same-day following PVI (same-day discharge group), and the remaining 30,336 patients stayed at least one night in the hospital (the overnight observation group). A propensity score analysis generated 1,751 matched pairs (440 in the same-day discharge group; 1311 in the observation overnight group). The 30-day readmission following discharge was not significantly higher in the same-day discharge group, compared to the overnight observation group (same-day discharge vs. overnight observation group: 12.7% vs. 9.7%, p=0.23; odds ratio [OR]:1.39, 95%confidence interval [CI]: 0.87–2.22) (Figure). Healthcare cost was significantly higher in the overnight observational group. ($25,237±14,036 vs. $30,749±16,383; p&amp;lt;0.01). Conclusion In this large nationwide study using a propensity score matching analysis, there was no significant difference in 30-day readmission rates following the same-day discharge in patients receiving PVI for AF compared with the overnight observation protocol. Funding Acknowledgement Type of funding sources: None.

Hospital readmission and mortality associations to frailty in hospitalized patients with coronary heart disease

BackgroundFrailty is associated with poor quality outcomes. ObjectiveTo examine associations between frailty and hospital readmission or mortality in Coronary Heart Disease (CHD). MethodsRetrospectively assessed the 2016 US Nationwide Readmissions Database (NRD) including adults ≥ 65 years with pre-existing CHD. A validated Hospital Frailty Risk Score (HFRS) using ICD-10-CM codes identified frailty risk. Outcomes included: Readmission (30-day and subsequent readmission after index event) and in-hospital morality (during index event, readmission, and at 30-day readmission). ResultsAmong 1.1 million eligible patients, low, intermediate, and high frailty risk accounted for 48.9%, 46.7%, and 4.4% of the sample. Compared to low frailty risk, intermediate and high frailty risk showed significantly higher overall readmission rates (40.9% vs. 31.4%, 41.7% vs. 31.4%) and 30-day readmission rates (21.9% vs. 15.7%, 23.5% vs. 15.7%), respectively. After adjustment, higher in-hospital mortality and readmission rates were associated with higher frailty risk. The associations between in-hospital mortality and frailty depended on the presence of acute coronary syndrome. ConclusionsReadmission and mortality rates increased proportionally to the level of frailty risk in older adults with CHD. CHD, frailty risk, and older age profoundly negatively impact health outcomes and increases risk of death and readmission.

Ninety-Day Readmission After Open Surgical Repair of Stanford Type A Aortic Dissection

BackgroundInvestigations into readmissions after surgical repair of acute Stanford type A aortic dissection (TAAD) remain scarce. We analyzed potential risk factors for readmission after TAAD. MethodsThe 2013 to 2014 US Nationwide Readmissions Database was queried for TAAD index hospitalizations and 90-day readmissions indicated by diagnostic and procedural codes. Multivariable analysis was completed to identify risk factors and the most common reasons for readmission. ResultsWe identified 6975 patients (65% men; mean age, 60.0 ± 0.4 years) who underwent surgical repair for TAAD. Overall 2062 patients (29.6%) were readmitted within 90 days: 634 (30.7%) during the first 30 days and 1428 (69.3%) during days 31 through 90. Readmitted patients had a higher prevalence of chronic kidney disease at index admission (18.0% vs 11.6%, P = .002), greater overall index length of stay (17.8 ± 0.6 vs 15. 5 ± 0.4 days; P = .0003), and greater index hospitalization cost ($90,637 ± $2691 vs $80,082 ± $2091; P = .0003). Mortality during readmission was 3.6% (n = 74). Indications for readmission were most commonly cardiac (26.2%), infectious (17.8%), and pulmonary (11.7%). Multivariate analysis identified 2 independent risk factors for readmission: acute kidney injury (odds ratio, 1.49; 95% confidence interval, 1.24-1.78; P < .0001) and an Elixhauser comorbidity index > 4 (odds ratio, 1.26; 95% confidence interval, 1.06-1.49; P = .009). ConclusionsAfter surgical repair of TAAD, approximately 30% of patients were readmitted within 90 days, two-thirds of them during the 31- to 90-day period. Targeted improvements in perioperative care and postdischarge follow-up of patients with multiple comorbidities could mitigate readmission rates. Efforts to reduce readmissions should be continued throughout the 90-day period.