Giuseppe Di Tano1, Renata De Maria2, Lucio Gonzini3, Nadia Aspromonte4, Andrea Di Lenarda5, Mauro Feola6, Marco Marini7, Massimo Milli8, Gianfranco Misuraca9, Andrea Mortara10, Fabrizio Oliva11, Giovanni Pulignano12, Giulia Russo5, Michele Senni13, Luigi Tavazzi14. 1. Cardiology Department, Istituti Ospitalieri, Cremona, Italy. 2. CNR Clinical Physiology Institute, Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy. 3. ANMCO Research Centre, Florence, Italy. 4. Cardiology Department, Ospedale San Filippo Neri, Rome, Italy. 5. Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy. 6. Cardiovascular Rehabilitation, Heart Failure Unit, Ospedale Maggiore SS, Trinità, Fossano, Italy. 7. Cardiology Department, Ospedali Riuniti, Umberto I-Lancisi-Salesi, Ancona, Italy. 8. Cardiology, Ospedale Santa Maria Nuova, Florence, Italy. 9. Cardiology Department, Ospedale dell'Annunziata, Cosenza, Italy. 10. Cardiology Department, Policlinico di Monza, Monza, Italy. 11. Cardiologia 2 Heart Failure and Heart Transplant Programme, 'A. De Gasperis' Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy. 12. Heart Failure Clinic, 1st Cardiology/CCU Unit, Cardiovascular Department, San Camillo Hospital, Rome, Italy. 13. Cardiovascular Department, Cardiology 1, Papa Giovanni XXIII Hospital, Bergamo. 14. Maria Cecilia Hospital-GVM Care&Research-E.S. Health Science Foundation, Cotignola, Italy.
Abstract
AIMS: Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial. METHODS AND RESULTS: Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age. CONCLUSION: A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.
AIMS: Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial. METHODS AND RESULTS: Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age. CONCLUSION: A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failurepatients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.
Authors: T Bittermann; R A Hubbard; M Serper; J D Lewis; S F Hohmann; L B VanWagner; D S Goldberg Journal: Am J Transplant Date: 2017-11-17 Impact factor: 8.086
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