Fei Wang1, Lee H Sterling2, Aihua Liu3, James M Brophy1, Gilles Paradis4, Ariane Marelli5. 1. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada; Division of Cardiology, McGill University Health Centre, Montréal, Quebec, Canada. 2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Division of Cardiology, McGill University Health Centre, Montréal, Quebec, Canada. 4. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada. 5. Division of Cardiology, McGill University Health Centre, Montréal, Quebec, Canada. Electronic address: ariane.marelli@mcgill.ca.
Abstract
BACKGROUND: Hospital readmissions are common in adults with congenital heart disease (CHD) with heart failure (HF). We sought to examine the temporal risk of readmissions, the prompting diagnoses and their determinants within one-year after a first HF hospitalization in older CHD patients. METHOD: We assembled a cohort from the Quebec CHD database of patients whose first-ever HF hospitalization occurred after age 40. Subjects were followed from the first HF discharge to the earliest of all-cause readmission, death, or one-year post-discharge. The Fine and Gray model was used to measure the weekly readmission risks. The one-year period was categorized into different stages based on readmission risks. A multinomial logistic regression model was adopted to identify the determinants of patients falling in different readmission stages. RESULTS: The one-year death-adjusted cumulative readmission risk was 48.8%. The absolute weekly risk of readmission was the highest at week 2, declined by 50% at week 8, and reached a plateau at week 27. Three phases-vigilance (1-8 weeks), transition (9-27 weeks), and plateau (28-52 weeks)-were identified, corresponding to high-risk, decreasing-risk, and stable-risk periods. Cardiovascular diseases accounted for 61.7%, 50.3%, and 43.2% of all readmissions during the three phases; systemic diseases accounted for 15.2%, 19.9%, and 31.2%. A history of past-12-month interventional procedures saw significantly decreased readmission risks. Longer hospital stays were associated with lower readmission risks at the vigilance phase only. CONCLUSION: Policy makers and caregivers should account for the change in risk over time, and phase-tailored strategies should be planned to effectively reduce readmissions.
BACKGROUND: Hospital readmissions are common in adults with congenital heart disease (CHD) with heart failure (HF). We sought to examine the temporal risk of readmissions, the prompting diagnoses and their determinants within one-year after a first HF hospitalization in older CHD patients. METHOD: We assembled a cohort from the Quebec CHD database of patients whose first-ever HF hospitalization occurred after age 40. Subjects were followed from the first HF discharge to the earliest of all-cause readmission, death, or one-year post-discharge. The Fine and Gray model was used to measure the weekly readmission risks. The one-year period was categorized into different stages based on readmission risks. A multinomial logistic regression model was adopted to identify the determinants of patients falling in different readmission stages. RESULTS: The one-year death-adjusted cumulative readmission risk was 48.8%. The absolute weekly risk of readmission was the highest at week 2, declined by 50% at week 8, and reached a plateau at week 27. Three phases-vigilance (1-8 weeks), transition (9-27 weeks), and plateau (28-52 weeks)-were identified, corresponding to high-risk, decreasing-risk, and stable-risk periods. Cardiovascular diseases accounted for 61.7%, 50.3%, and 43.2% of all readmissions during the three phases; systemic diseases accounted for 15.2%, 19.9%, and 31.2%. A history of past-12-month interventional procedures saw significantly decreased readmission risks. Longer hospital stays were associated with lower readmission risks at the vigilance phase only. CONCLUSION: Policy makers and caregivers should account for the change in risk over time, and phase-tailored strategies should be planned to effectively reduce readmissions.