Correlates of Early Hospital Readmission or Death in Patients With Congestive Heart Failure
Section snippets
Study Population
We prospectively enrolled patients admitted nonelectively with heart failure in 1993 and 1994 to the Brigham and Women's Hospital, a 751-bed urban teaching hospital.13, 14With approval of the human research committee, each day a study investigator or a trained research assistant reviewed the chart of every patient with a cardiac, pulmonary, or renal admission diagnosis. Patients were eligible for the study if they had both a complaint of shortness of breath or fatigue and had pulmonary edema,
Description of Patient Population
Compared with the nonenrolled patients, patients in the study were more likely to be aged ≤70 years (62% vs 53%, p = 0.06), to have an initial respiratory rate ≤30 breaths/min (89% vs 81%, p = 0.02), and to be white (72% vs 60%, p = 0.02). Among the 257 enrolled patients, the average age was 67 years and 51% were women. Two thirds had a prior history of congestive heart failure, 37% had had a myocardial infarction, and 64% had a history of hypertension. One quarter had a yearly income ≤$7,500,
Discussion
Hospital readmission within 60 days of discharge was frequent in our cohort, occurring in approximately one third of these patients with heart failure. We were able to find independent risk factors for particularly high rates of readmission or death, but conversely we were unable to identify a truly low-risk group of patients.
Among patients with congestive heart failure, readmissions are common events, occurring in 20% to 50% of patients within 14 days to 6 months after discharge.1, 3, 6, 8, 9,
Acknowledgements
We would like to thank Cynthia Crespin, EdM, Jeffrey Geller, MD, Julie Newton, and Alexander Pedan, PhD, for their technical assistance, and Nicholas Christakis, MD, PhD, MPH, Peter Friedmann, MD, MPH, and Theodore Karrison, PhD, for their helpful reviews of the manuscript.
Dr. Chin is supported by Geriatric Academic Program Award 5-K12-AG-00488 from the National Institutes of Health/National Institute on Aging, Bethesda, Maryland.
References (21)
- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chron Dis
(1987) - et al.
A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization
Am J Cardiol
(1997) - et al.
Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure
Am Heart J
(1995) - et al.
Readmission after hospitalization for congestive heart failure among Medicare beneficiaries
Arch Intern Med
(1997) - et al.
Selecting disease-outcome pairs for monitoring the quality of hospital care
Med Care
(1995) - et al.
Hospital readmissions among the elderly
J Am Geriatr Soc
(1985) - et al.
Patients requiring at least five admissions in 1 year: data from Washington state
Med Care
(1991) - et al.
Factors predicting readmission of older general medicine patients
J Gen Intern Med
(1991) - et al.
Effect of DRGs on three-month readmission rate of geriatric patients with congestive heart failure
Am J Public Health
(1988) Management Strategies in Heart Failure: Optimizing Practice, Outcome, and Cost
(1996)
Cited by (250)
The impact of sources of perceived social support on readmissions in patients with heart failure
2022, Journal of Psychosomatic ResearchPrediction Model Using Machine Learning for Mortality in Patients with Heart Failure
2021, American Journal of CardiologyPredicting High-Risk Patients and High-Risk Outcomes in Heart Failure
2020, Heart Failure ClinicsShort-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)
2020, European Journal of Internal Medicine