Brijesh Patel1, George Prousi2, Mahek Shah3, Paul Secheresiu2, Lohit Garg3, Manyoo Agarwal4, Shantanu Patil5, Rahul Gupta6, Bruce Feldman3. 1. Department of Cardiology, Lehigh Valley Hospital Network, Allentown, PA. Electronic address: b2patel@gmail.com. 2. Department of Internal Medicine, Lehigh Valley Hospital Network, Allentown, PA. 3. Department of Cardiology, Lehigh Valley Hospital Network, Allentown, PA. 4. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN. 5. Department of Medicine, SSM Health St Mary's Hospital, St Louis, MO. 6. Department of Internal Medicine, New York Medical College, Valhalla, NY.
Abstract
OBJECTIVE: To determine the readmission rate in patients with acute heart failure (AHF) discharged against medical advice (AMA). METHODS: We performed a retrospective analysis using the 2014 National Readmission Database. Patients admitted with a primary diagnosis of AHF were selected. Only those discharged to home and who left AMA were included in the study. The primary outcome was 30-day readmission. We compared the readmission rates among those discharged AMA vs routinely discharged patients using propensity score matching (PSM) to address imbalance in variables between the 2 groups. We matched 3 routinely discharged patients to 1 patient who left AMA. RESULTS: We identified 273,489 patients with AHF, of whom 116,869 qualified for further study analysis. A total of 2014 patients (1.7%) were in the AMA group and 114,855 (98.3%) were in the routinely discharged group. After PSM, 6042 routinely discharged patients were matched with 2014 patients from the AMA group. The standard mean difference for each variable was less than 10% postmatching. The 30-day readmission rate among those who left AMA was higher than among those routinely discharged (33% vs 20.1%; P<.001). Heart failure (44.8%) was the most common cause of readmission in the AMA group. Patients who left AMA were more likely to be readmitted to a different hospital compared with those routinely discharged (37.4 vs 23.1%; P<.001). They also had a high rate of leaving AMA during the readmission (18 vs 2%; P<.001). CONCLUSION: Patients with AHF discharged AMA had a significantly higher 30-day readmission rate than did the routinely discharged group.
OBJECTIVE: To determine the readmission rate in patients with acute heart failure (AHF) discharged against medical advice (AMA). METHODS: We performed a retrospective analysis using the 2014 National Readmission Database. Patients admitted with a primary diagnosis of AHF were selected. Only those discharged to home and who left AMA were included in the study. The primary outcome was 30-day readmission. We compared the readmission rates among those discharged AMA vs routinely discharged patients using propensity score matching (PSM) to address imbalance in variables between the 2 groups. We matched 3 routinely discharged patients to 1 patient who left AMA. RESULTS: We identified 273,489 patients with AHF, of whom 116,869 qualified for further study analysis. A total of 2014 patients (1.7%) were in the AMA group and 114,855 (98.3%) were in the routinely discharged group. After PSM, 6042 routinely discharged patients were matched with 2014 patients from the AMA group. The standard mean difference for each variable was less than 10% postmatching. The 30-day readmission rate among those who left AMA was higher than among those routinely discharged (33% vs 20.1%; P<.001). Heart failure (44.8%) was the most common cause of readmission in the AMA group. Patients who left AMA were more likely to be readmitted to a different hospital compared with those routinely discharged (37.4 vs 23.1%; P<.001). They also had a high rate of leaving AMA during the readmission (18 vs 2%; P<.001). CONCLUSION:Patients with AHF discharged AMA had a significantly higher 30-day readmission rate than did the routinely discharged group.