The rate and time to first readmission in patients discharged with a diagnosis of acute decompensated heart failure admitted to the cardiology department, Ayub Teaching Hospital, Abbottabad | [Journal of Ayub Medical College • 2024]

Author(s):

1. Saad Shams: Department of Cardiology, Ayub Medical College Abbottabad-,,Pakistan

2. Mohammad Imran Khan: Department of Cardiology, Ayub Medical College Abbottabad-,,Pakistan

3. Rukhshanda Afsar: Department of Cardiology, Ayub Medical College Abbottabad-,,Pakistan

4. Fatima Javed: Department of Health Govt of Khyber Pakhtunkhwa Pakistan,,Pakistan

5. Zia Ullah Khan: Department of Cardiology, Ayub Medical College Abbottabad-,,Pakistan

6. Aftab Ahmad: Department of Cardiology, Ayub Medical College Abbottabad-,,Pakistan

7. Mati Ullah Khan: Department of Cardiology, Ayub Medical College Abbottabad-,,Pakistan

Abstract:

Background: Admission for heart failure poses a significant risk of readmission. Evaluating readmission rates in settings lacking chronic disease management programs could provide valuable insights to advocate for the establishment of such services. Methods: This study focused on patients admitted to the Cardiology Department of Ayub Medical Teaching Institute with acute decompensated heart failure. After excluding patients based on exclusion criteria, demographic and clinical data were recorded, including symptoms, signs, discharge medications, and readmission status within 6 months. Patients not readmitted were contacted via telephone at 1, 3, and 6 months. Readmission rates and time to first readmission or death were documented. Results: A total of 222 patients were enrolled, with 60% being males. All patients exhibited pulmonary congestion, with 85% classified as NYHA Class III or IV. Comorbidities included hypertension (59%), history of myocardial infarction (45.49%), and diabetes (38.28%). Within 6 months, 21% of patients were readmitted, and 13% died before readmission, resulting in an overall death or readmission rate of 34% at 6 months. No significant differences were observed between readmitted and non-readmitted patients regarding sex, age, creatinine levels, haemoglobin levels, sodium levels, or ejection fraction. Utilization of guideline-directed medical treatment was low. Conclusion: The high rate of readmission or death among patients admitted with acute decompensated heart failure underscores the necessity for implementing multidisciplinary care to closely monitor these patients.

Page(s): 686-691

DOI: 10.55519/JAMC-04-13550

Published: Journal: Journal of Ayub Medical College, Volume: 36, Issue: 4, Year: 2024

Keywords:

Acute decompensated heart failure , Heart failure , Readmission

References:

[1] Kemp CD,Conte JV .2012 .The pathophysiology of heart failure. Cardiovasc Pathol, 21(5) : 365-371.

[2] .2018 .-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159) : 1789-1858.

[3] Belfiore A,Palmieri VO,Di Gennaro C,Settimo E,De Sario MG,Lattanzio S .2020 .Long-term Management of Chronic Heart Failure Patients in Internal Medicine. Intern Emerg Med, 15(1) : 49-58.

[4] Gheorghiade M,Vaduganathan M,Fonarow GC,Bonow RO .2013 .Rehospitalization for heart failure. Problems and perspectives. J Am Coll Cardiol, 61(4) : 391-403.

[5] McLaren DP,Jones R,Plotnik R,Zareba W,McIntosh S,Alexis J .2016 .Prior hospital admission predicts thirty-day hospital readmission for heart failure patients. Cardiol J, 23(2) : 155-62.

[6] Ranasinghe I,Wang Y,Dharmarajan K,Hsieh AF,Bernheim SM,Krumholz HM .2014 .Readmissions after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study. PLoS Med, 11(9) : e1001737.

[7] McAlister FA,Stewart S,Ferrua S Mcmurray JJ .2004 .Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol, 44(4) : 810-9.

[8] Wideqvist M,Cui X,Magnusson C,Schaufelberger M,Fu M. .2021 .Hospital readmissions of patients with heart failure from the real world: timing and associated risk factors. ESC Heart Fail, 8(2) : 1388-97.

[9] Suter LG,Li SX,Grady JN,Lin Z,Wang Y,Bhat KR .2014 .National patterns of risk-standardized mortality and readmission after hospitalization for acute myocardial infarction, heart failure, and pneumonia: update on publicly reported outcomes measures based on the 2013 release. J Gen Intern Med, 29(10) : 1333-40.

[10] Wasfy JH,Zigler CM,Choirat C,Wang Y,Dominici F,Yeh RW .2017 .Readmission rates after passage of the hospital readmissions reduction program: a pre-post analysis. Ann Intern Med, 166(5) : 324-331.

[11] Shah KS,Xu H,Matsouaka RA,Bhatt DL,Heidenreich PA,Hernandez AF .2017 .Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. Am Coll Cardiol, 70(20) : 2476-86.

[12] Krumholz HM,Parent EM,Tu N,Vaccarino V,Wang Y,Radford MJ Y .1997 .Readmission After Hospitalization for Congestive Heart Failure among Medicare Beneficiaries. Arch Intern Med, 157 : 99-104.

[13] Rich MW,Vinson JM,Sperry JC,Shah AS,Spinner LR,Chung MK .1993 .Prevention of readmission in elderly patients with congestive heart failure - Results of a prospective, randomized pilot study. J Gen Intern Med, 8(11) : 585-90.

[14] Vinson JM,Rich MW,Sperry JC,Shah AS,McNamara T .1990 .Early Readmission of Elderly Patients with Congestive Heart Failure. J Am Geriatr Soc, 38(12) : 1290-5.

[15] Gerber Y,Weston SA,Redfield MM,Chamberlain AM,Manemann SM,Jiang R .2015 .A contemporary appraisal of the heart failure epidemic in Olmsted County. JAMA Intern Med, 175(6) : 996-1004.

[16] Smeets M,Vaes B,Mamouris P,Van Den Akker M,Van Pottelbergh G,Goderis G .2019 .Burden of heart failure in Flemish general practices: a registry-based study in the Intego database. BMJ Open, 9(1) : e022972.

[17] Christiansen MN,Køber L,Weeke P,Vasan RS,Jeppesen JL,Smith JG .2017 .Age-specific trends in incidence, mortality,and comorbidities of heart failure in Denmark,1995 to 2012. Circulation, 135(13) : 1214-23.

[18] Lip GY,Skjøth F,Overvad K,Rasmussen LH,Larsen TB .2015 .Blood pressure and prognosis in patients with incident heart failure: the Diet, Cancer, and Health(DCH) cohort study. Clin Res Cardiol, 104(12) : 1088-96.

[19] Ather S,Chan W,Bozkurt B,Aguilar D,Ramasubbu K,Zachariah AA .2012 .Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol, 59(11) : 998-1005.

[20] Al-Tamimi MAA,Gillani SW,Abd Alhakam ME,Sam KG .2021 .Factors Associated with Hospital Readmission of Heart Failure Patients. Front Pharmacol, 12 : 732760.

[21] Ponikowski P,Anker SD,AlHabib KF,Cowie MR,Force TL,Hu S .2014 .Heart failure: preventing disease and death worldwide. ESC Heart Fail, 1(1) : 4-25.

[22] Parizo JT,Kohsaka S,Sandhu AT,Patel J,Heidenreich PA .2020 .Trends in Readmission and Mortality Rates Following Heart Failure Hospitalization in the Veterans Affairs Health Care System From 2007 to 2017. JAMA Cardiol, 5(9) : 1042-7.

[23] Hafkamp FJ,Tio RA,Otterspoor LC,de Greef T,Steenbergen GJ,van de Ven ART .2022 .Optimal effectiveness of heart failure management - an umbrella review of metaanalyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev, 27(5) : 1683-1748.

[24] McDonagh TA,Cleland J,Dargttie H,Whittaker T,Standing M,Mitchell P .2012 .. National Heart Failure report: April 2010- March 2011. National Institute For Cardiovascular Outcomes Research (NICOR), : .

[25] Hansen LO,Young RS,Hinami K,Leung A,Williams MV .2011 .Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Ann Intern Med, 155(8) : 520-8.

[26] Tuso P,Watson HL,Garofalo-Wright L,Lindsay G,Jackson A,Taitano M,Koyama S,Kanter M. .2014 .Complex case conferences associated with reduced hospital admissions for high-risk patients with multiple comorbidities. Perm J, 18(1) : 38-42.

[27] Cleland JG,Swedberg K,Follath F,Komajda M,Cohen-Solal A,Aguilar JC .2003 .The EuroHeart Failure Survey Programme: Survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis. Eur Heart J, 24 : 442-63.

[28] McDonald K,Ledwidge M,Cahill J,Quigley P,Maurer B,Travers B .2002 .Heart Failure Management: Multidisciplinary Care Has Intrinsic Benefit above the Optimization of Medical Care. J Card Fail, 893 : 142-8.

[29] Cox ZL,Nandkeolyar S,Johnson AJ,Lindenfeld J,Rali AS .2022 .In-hospital Initiation and Up-titration of Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction. Card Fail Rev, 8 : e21.

[30] Greene SJ,Butler J,Albert NM,DeVore AD,Sharma PP,Duffy CI .2018 .Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J Am Coll Cardiol, 72(4) : 351-66.

[31] Driscoll A,Krum H,Wolfe R,Tonkin A .2011 .Nurse-led titration of beta-blockers can improve outcomes in chronic heart failure patients in the community. J Card Fail, 17 : 224-30.

[32] Driscoll A,Currey J,Tonkin A,Krum H .2015 .Nurse-led titration of angiotensin converting enzyme inhibitors, beta-adrenergic blocking agents and angiotensin receptor blockers for patients with left ventricular systolic dysfunction Review. Cochrane Database Syst Rev, 12 : CD009889.

[33] Driscoll A,Meagher S,Kennedy R,Hay M,Banerji J,Campbell D .2016 .What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review?. BMC Cardiovasc Disord, 16(1) : 195.

[34] Baptiste DL,Mark H,Groff-Paris L,Taylor LA L .2014 .A nurseguided patient- centered heart failure education program. J Nurs Educ Pract, 4(3) : 49-57.

[35] Akosah KO,Schaper AM,Havlik P,Barnhart S,Devine S. .2002 .Improving care for patients with chronic HF in the community: the importance of a disease management programs. Chest, 122(2) : 906-12.

[36] Krumholz HM,Amatruda J,Smith GL,Mattera JA,Roumanis SA,Radford MJ .2002 .Randomized trial of an education and support intervention to prevent readmission of patients with HF. J Am Coll Cardiol, 39(1) : 83-9.

[37] . .. Submitted: August 1, : 2023.

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