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Inicio Medicina Clínica Short term prognosis of heart failure after first hospital admission
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Vol. 154. Issue 2.
Pages 37-44 (January 2020)
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Vol. 154. Issue 2.
Pages 37-44 (January 2020)
Original article
Short term prognosis of heart failure after first hospital admission
Pronóstico a corto plazo al alta de la primera hospitalización por insuficiencia cardíaca
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11
Joan Masipa,
Corresponding author
joan2masip@gmail.com

Corresponding author.
, Francesc Formigab, Josep Comín-Coletc,d,e, Xavier Corbellab,f
a Medical Coding Unit, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
b Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
c Heart Failure Program, Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
d Cardiovascular Diseases Research Group, Research Programme in Inflammatory, Chronic and Degenerative Diseases, IDIBELL (Bellvitge Biomedical Research Institute), Hospitalet de Llobregat, Barcelona, Spain
e Heart Diseases Biomedical Research Group, Research Programme in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park, Barcelona, Spain
f Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Statistics
Tables (4)
Table 1. Patient characteristics according to readmission status 30 days after index discharge (N=3642 patients discharged alive after first hospitalization).
Table 2. Multivariate analysis.
Table 3. Patient characteristics according to vital status 30 days after index discharge (N=3642 patients discharged alive after first hospitalization).
Table 4. Patient characteristics according to adverse event (either death or readmission) 30 days after index discharge (N=3642 patients discharged alive after first hospitalization).
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Abstract
Background

Death and unexpected readmission are frequent among heart failure patients. We aimed to assess 30-day readmission and mortality rate as well as to identify predictive factors for patients discharged from a first HF related hospital admission.

Methods and results

Retrospective, single-center, cohort study, using administrative data from a tertiary care hospital in Barcelona, Spain. Patients discharged alive from a first HF related admission from 2010 to 2014 were assessed for 30-day death, readmission and adverse outcome rate. A Linear Logistic Regression Model was fitted for each outcome.

The set accounted for 3642 patients; 50.1% female and 49.9% male. Mean age was 76 years (SD=12). 30-Days rates were 9.2% for readmission, 5.6% for death and 13.8% for adverse outcome. Admission to an ED within 30 days was strongly linked to readmission (OR=6.97), death (OR=2.31) and adverse outcome (OR=8.55), as well as chronic kidney disease (OR=1.44/1.61/2.86 respectively). Discharge to a Long Stay Care (LSC) facility was linked to lower readmission and adverse event rates (OR=.57 and OR=.15).

Conclusion

Pre and post-index discharge use of health care resources is related to adverse outcome rates. Our findings point out the potential benefit for a more tailored approach in the management of HF patients.

Keywords:
Heart failure
Mortality
Readmission
Prognosis
First hospital admission
Resumen
Antecedentes

La muerte y readmisión no programada son frecuentes en pacientes con insuficiencia cardiaca (IC). En este estudio evaluamos las tasas y los factores predictivos de muerte y readmisión a 30 días tras el alta de una primera hospitalización por IC.

Métodos y resultados

Se trata de un estudio de cohorte retrospectivo, unicéntrico, que utiliza datos administrativos de un hospital de tercer nivel en Barcelona, España. Para los pacientes dados de alta vivos, tras un primer episodio de hospitalización por IC descompensada, entre 2010 y 2014, se calcularon las tasas de muerte, readmisión y evento adverso durante los 30 días tras el alta. Para cada variable de interés se ajustó un modelo de regresión logística.

La muestra constaba de 3.642 pacientes: 50,1% mujeres y 49,9% varones con una edad media de 76 años (DE=12). Las tasas a los 30 días fueron del 9,2% para la readmisión, 5,6% para la muerte y 13,8% para el evento adverso. Haber sido visitado un servicio de urgencias en el periodo de estudio se asoció a una mayor tasa de readmisión (OR=6,97), muerte (OR=2,31) y evento adverso (OR=8,55), del mismo modo que la insuficiencia renal crónica (OR=1,44/1,61/2,86, respectivamente). El traslado al alta a un centro de larga estancia se asoció a una menor tasa de admisiones y eventos adversos (OR=0,57 y OR=0,15).

Conclusiones

El uso de servicios sanitarios pre y postalta guarda una clara relación con la tasa de eventos adversos. Nuestros resultados indican el beneficio potencial de un manejo personalizado de los pacientes con IC.

Palabras clave:
Insuficiencia cardíaca
Mortalidad
Readmisión
Pronóstico
Primera hospitalización

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