1
|
Ayenew B, Kumar P, Hussein A, Gashaw Y, Girma M, Ayalew A, Tadesse B. Heart failure drug classes and 30-day unplanned hospital readmission among patients with heart failure in Ethiopia. J Pharm Health Care Sci 2023; 9:49. [PMID: 38012803 PMCID: PMC10680257 DOI: 10.1186/s40780-023-00320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Drug therapy is a crucial aspect of heart failure management and has been shown to reduce morbidity and mortality in heart failure patients. However, the comparative effects of these drug classes on readmission rates have not been well studied. Therefore, the aim of this study was to examine the association between different classes of heart failure drugs and 30-day readmission rates in patients with heart failure. METHOD A multicenter, hospital-based retrospective cohort design was employed and 572 randomly selected patients with heart failure were included. Data were entered in Epi-data version 4.6 and analyzed with STATA version 17. Kaplan-Meier and log-rank tests were used to estimate and compare survival time. A Cox proportional hazard model was utilized, employing both bi-variable and multi-variable analyses, to examine the effect of predictors on the timing of unplanned hospital readmissions. The strength of the association was assessed using an adjusted hazard ratio (aHR), and statistical significance was declared for p-values < 0.05 and a 95% confidence interval (CI). RESULTS In this study, a total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. In the multivariate cox proportional hazards analysis being an age (> 65 year) (AHR: 2.34, 95%CI: 1.63, 3.37), rural in residency (AHR: 1.85, 95%CI: 1.07, 3.20), hospital stays > 7 Days (AHR: 3.68, 95%CI: 2.51,5.39), discharge with Diuretics (AHR: 2.37, 95%CI: 1.45, 3.86), and discharge with Beta-Blocker (AHR: 0.48, 95%CI: 0 0.34, 0.69) were identified as independent predictors of unplanned hospital readmission. CONCLUSION Elderly patients, being in rural areas, longer hospital stays, and discharges of patients on diuretics and not on beta-blockers were independent predictors of unplanned hospital readmission. Therefore, working on these factors will help to reduce the hazard of unplanned hospital readmissions, improve patient outcomes, and increase the efficiency of heart failure management.
Collapse
Affiliation(s)
- Birhanu Ayenew
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Prem Kumar
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Adem Hussein
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Yegoraw Gashaw
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Mitaw Girma
- Department of Comprehensive Health Nursing, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abdulmelik Ayalew
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Beza Tadesse
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| |
Collapse
|
2
|
Bioletto F, Evangelista A, Ciccone G, Brunani A, Ponzo V, Migliore E, Pagano E, Comazzi I, Merlo FD, Rahimi F, Ghigo E, Bo S. Prediction of Early and Long-Term Hospital Readmission in Patients with Severe Obesity: A Retrospective Cohort Study. Nutrients 2023; 15:3648. [PMID: 37630838 PMCID: PMC10458036 DOI: 10.3390/nu15163648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Adults with obesity have a higher risk of hospitalization and high hospitalization-related healthcare costs. However, a predictive model for the risk of readmission in patients with severe obesity is lacking. We conducted a retrospective cohort study enrolling all patients admitted for severe obesity (BMI ≥ 40 kg/m2) between 2009 and 2018 to the Istituto Auxologico Italiano in Piancavallo. For each patient, all subsequent hospitalizations were identified from the regional database by a deterministic record-linkage procedure. A total of 1136 patients were enrolled and followed up for a median of 5.7 years (IQR: 3.1-8.2). The predictive factors associated with hospital readmission were age (HR = 1.02, 95%CI: 1.01-1.03, p < 0.001), BMI (HR = 1.02, 95%CI: 1.01-1.03, p = 0.001), smoking habit (HR = 1.17, 95%CI: 0.99-1.38, p = 0.060), serum creatinine (HR = 1.22, 95%CI: 1.04-1.44, p = 0.016), diabetes (HR = 1.17, 95%CI: 1.00-1.36, p = 0.045), and number of admissions in the previous two years (HR = 1.15, 95%CI: 1.07-1.23, p < 0.001). BMI lost its predictive role when restricting the analysis to readmissions within 90 days. BMI and diabetes lost their predictive roles when further restricting the analysis to readmissions within 30 days. In conclusion, in this study, we identified predictive variables associated with early and long-term hospital readmission in patients with severe obesity. Whether addressing modifiable risk factors could improve the outcome remains to be established.
Collapse
Affiliation(s)
- Fabio Bioletto
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Amelia Brunani
- Rehabilitation Medicine Unit, IRCCS Istituto Auxologico Italiano Piancavallo, 28824 Oggebbio, Italy;
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Enrica Migliore
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Eva Pagano
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Isabella Comazzi
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Fabio Dario Merlo
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (F.R.)
| | - Farnaz Rahimi
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (F.R.)
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Simona Bo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| |
Collapse
|
3
|
Deguchi T, Sato M, Kohyama N, Fujita K, Nagumo S, Suzuki H, Ebato M, Kogo M. Development of a model predicting cardiac events in heart failure patients with decreased renal function: a retrospective study. Int J Clin Pharm 2023; 45:210-219. [PMID: 36414822 DOI: 10.1007/s11096-022-01502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inappropriate and multiple medications affect the prognosis of patients with acute decompensated heart failure (ADHF). However, in ADHF patients with decreased renal function, there have been no reports on prognostic factors, including medication data, or models for predicting cardiac events. AIM To develop a model including medication data to predict cardiac events in ADHF patients with decreased renal function. METHOD This retrospective cohort study included 443 first-time admitted ADHF patients with decreased renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m2 at discharge) in the Showa University Fujigaoka Hospital. The primary outcome was cardiac events within one year after discharge, defined as the composite of HF readmission, HF mortality, and cardiovascular mortality. The model for predicting cardiac events was developed using predictive factors extracted by multivariable analysis. The cardiac events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. RESULTS The incidence of cardiac events within one year after discharge was 20.1%. By multivariable analysis, we observed that atrial fibrillation, weight loss < 5%, brain natriuretic peptide ≥ 200 pg/mL, polypharmacy, and beta-blockers use below target dosage were significantly associated with an increased risk of cardiac events. The developed model, the cardiac events rate in the high-risk group was significantly higher than in the low-risk group (41.0 vs. 9.2%, p < 0.001). CONCLUSION The developed model for predicting cardiac events will be useful in decision-making to support appropriate early management of ADHF patients with decreased renal function.
Collapse
Affiliation(s)
- Tomokazu Deguchi
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan. .,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Miki Sato
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Noriko Kohyama
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Kanako Fujita
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan.,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mari Kogo
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| |
Collapse
|
4
|
Epstein E, Schale S, Brambatti M, You H, Hansen P, McCain J, Lin J, Greenberg B. Impact of Transitioning Patients to Oral Diuretics 24 Hours Before Discharge from Heart Failure Hospitalization on 30 Day Outcomes. Int J Cardiol 2022; 364:72-76. [PMID: 35738415 DOI: 10.1016/j.ijcard.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients hospitalized for heart failure (HF) are at high risk for post-discharge events. Although transition from intravenous to oral diuretics for >24 hours is commonly practiced to reduce post-discharge risk, evidence supporting this strategy is limited. We investigated the impact of this practice on 30 day post-discharge outcomes following HF hospitalization at our institution. METHODS Retrospective chart review of patients hospitalized with a primary HF diagnosis, discharged on oral diuretic, and followed at our institution. Admission, in-hospital, and pre-discharge characteristics of patients discharged with >24-hour observation were compared to those of patients observed for <24-hours on oral diuretics. Differences between groups in composite 30 day all-cause mortality and rehospitalization, each component, and HF rehospitalization were assessed. RESULTS Of 285 patients meeting entry criteria, 178 received oral diuretics >24 hours prior to discharge and 107 were discharged <24 hours after transitioning to oral diuretics. Baseline characteristics were similar between groups. Patients with >24 hours observation on oral diuretics had longer in-hospital stays and greater weight and net volume loss than those observed <24 hours. Patients receiving oral diuretics for <24 hours were more likely to have had neurohormonal drugs and diuretic dose changed within 24-hours of discharge. Oral diuretic treatment for >24 hours failed to reduce any study endpoint. CONCLUSIONS Transitioning patients to oral diuretics for >24 hours prior to discharge following HF hospitalization failed to improve 30-day outcomes. These results question this strategy for all patients hospitalized for worsening HF.
Collapse
Affiliation(s)
- Elizabeth Epstein
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Stephen Schale
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Michela Brambatti
- Cardiology Department, University of California San Diego Healthcare and Sulpizio Family Cardiovascular Center, La Jolla, CA
| | - Hyeri You
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla, CA
| | - Paul Hansen
- Cardiology Department, University of California San Diego Healthcare and Sulpizio Family Cardiovascular Center, La Jolla, CA
| | - Julia McCain
- Cardiology Department, University of California San Diego Healthcare and Sulpizio Family Cardiovascular Center, La Jolla, CA
| | - Jessica Lin
- Cardiology Department, University of California San Diego Healthcare and Sulpizio Family Cardiovascular Center, La Jolla, CA
| | - Barry Greenberg
- Cardiology Department, University of California San Diego Healthcare and Sulpizio Family Cardiovascular Center, La Jolla, CA.
| |
Collapse
|
5
|
Freedland KE, Steinmeyer BC, Carney RM, Skala JA, Chen L, Rich MW. Depression and Hospital Readmissions in Patients with Heart Failure. Am J Cardiol 2022; 164:73-78. [PMID: 34876275 DOI: 10.1016/j.amjcard.2021.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022]
Abstract
Depression increases the risk of mortality in patients with heart failure (HF). Less is known about whether depression predicts multiple readmissions or whether multiple hospitalizations worsen depression in patients with HF. This study aimed to test the hypotheses that depression predicts multiple readmissions in patients hospitalized with HF, and conversely that multiple readmissions predict persistent or worsening depression. All-cause readmissions were ascertained over a 2-year follow-up of a cohort of 400 patients hospitalized with HF. The Patient Health Questionnaire-9 was used to assess depression at index and 3-month intervals. At enrollment in the study, 21% of the patients were mildly depressed and 22% were severely depressed. Higher Patient Health Questionnaire-9 depression scores predicted a higher rate of readmissions (adjusted hazard ratio 1.02, 95% confidence interval 1.00 to 1.04, p = 0.03). The readmission rate was higher in those who were severely depressed than in those without depression (p = 0.0003), but it did not differ between patients who were mildly depressed and patients without depression. Multiple readmissions did not predict persistent or worsening depression, but younger patients in higher New York Heart Association classes were more depressed than other patients. Depression is an independent risk factor for multiple all-cause readmissions in patients hospitalized with HF. Severe depression is a treatable psychiatric co-morbidity that warrants ongoing clinical attention in patients with HF.
Collapse
Affiliation(s)
| | | | | | | | | | - Michael W Rich
- Cardiovascular Division of the Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| |
Collapse
|
6
|
Ekestubbe S, Fu M, Giang KW, Lindgren M, Rosengren A, Schioler L, Schaufelberger M. Increasing home-time after a first diagnosis of heart failure in Sweden, 20 years trends. ESC Heart Fail 2022; 9:555-563. [PMID: 34837891 PMCID: PMC8788024 DOI: 10.1002/ehf2.13714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/22/2021] [Accepted: 10/31/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS This study was performed to compare trends in home-time for patients with heart failure (HF) between those of working age and those of retirement age in Sweden from 1992 to 2012. METHODS AND RESULTS The National Inpatient Register (IPR) was used to identify all patients aged 18 to 84 years with a first hospitalization for HF in Sweden from 1992 to 2012. Information on date of death, comorbidities, and sociodemographic factors were collected from the Swedish National Register on Cause of Death, the IPR, and the longitudinal integration database for health insurance and labour market studies, respectively. The patients were divided into two groups according to their age: working age (<65 years) and retirement age (≥65 years). Follow-up was 4 years. In total, following exclusions, 388 775 patients aged 18 to 84 years who were alive 1 day after discharge from a first hospitalization for HF were included in the study. The working age group comprised 62 428 (16%) patients with a median age of 58 (interquartile range, 53-62) years and 31.2% women, and the retirement age group comprised 326 347 (84%) patients with a median age of 77 (interquartile range, 73-81) years and 47.4% women. Patients of working age had more home-time than patients of retirement age (83.8% vs. 68.2%, respectively), mainly because of their lower 4 year mortality rate (14.2% vs. 29.7%, respectively). Home-time increased over the study period for both age groups, but the increase levelled off for older women after 2007, most likely because of less reduction in mortality in older women than in the other groups. CONCLUSIONS This nationwide study showed increasing home-time over the study period except for women of retirement age and older for whom the increase stalled after 2007, mainly because of a lower mortality reduction in this group. Efforts to improve patient-related outcome measures specifically targeted to this group may be warranted.
Collapse
Affiliation(s)
- Sofia Ekestubbe
- Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Michael Fu
- Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kok Wai Giang
- Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Martin Lindgren
- Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Annika Rosengren
- Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Linus Schioler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Maria Schaufelberger
- Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| |
Collapse
|
7
|
Thyagaturu HS, Bolton AR, Li S, Kumar A, Shah KR, Katz D. Effect of Diabetes Mellitus on 30 and 90-Day Readmissions of Patients With Heart Failure. Am J Cardiol 2021; 155:78-85. [PMID: 34275590 DOI: 10.1016/j.amjcard.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
The prevalence of diabetes mellitus (DM) in hospitalized heart failure (HF) patients is increasing over time. However, the effect of DM on short-term readmissions for HF is not well established. We investigated the effects of DM on readmissions of HF patients. All adult hospitalizations with a primary diagnosis of HF were identified in the National Readmission Database (NRD) for 2018 and were categorized into those with and without a secondary diagnosis of DM. The primary outcome was to assess risk difference in 30 and 90-day all-cause readmissions. Multivariate Cox survival analysis and multivariate Cox regression were performed to estimate the readmission risk difference in HF patients with and without DM. Of 925,637 HF hospitalizations that met the inclusion criteria, 441,295 (47.6%) had concomitant DM. Diabetics hospitalized for HF had higher prevalence of obesity (37.3% vs 19.5%), kidney disease (58.4% vs 29.2%) and coronary disease (61.1% vs 51.0%), compared to HF hospitalizations without DM. In adjusted analyses, DM was associated with higher hazards for all-cause [hazards ratio (HR), 30 days: 1.04 (1.02-1.06); 90 days: 1.07 (1.05-1.09)], HF [HR, 30 days: 1.05 (1.02-1.07); 90 days: 1.08 (1.05-1.10)] and myocardial infarction (MI) [HR, 30 days: 1.26 (1.12-1.41); 90 days: 1.38 (1.25-1.52)] readmissions. In conclusion, in patients with HF-related hospitalizations, the presence of DM was associated with a higher risk of 30 and 90-day all-cause, HF and MI readmissions.
Collapse
Affiliation(s)
- Harshith S Thyagaturu
- Department of Internal Medicine and Cardiology, Bassett Medical Center, Cooperstown, New York.
| | | | - Si Li
- Department of Internal Medicine, Wright Medical Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kashyap R Shah
- Department of Internal Medicine, St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Daniel Katz
- Department of Internal Medicine and Cardiology, Bassett Medical Center, Cooperstown, New York
| |
Collapse
|
8
|
Li F, Xin H, Zhang J, Fu M, Zhou J, Lian Z. Prediction model of in-hospital mortality in intensive care unit patients with heart failure: machine learning-based, retrospective analysis of the MIMIC-III database. BMJ Open 2021; 11:e044779. [PMID: 34301649 PMCID: PMC8311359 DOI: 10.1136/bmjopen-2020-044779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The predictors of in-hospital mortality for intensive care units (ICUs)-admitted heart failure (HF) patients remain poorly characterised. We aimed to develop and validate a prediction model for all-cause in-hospital mortality among ICU-admitted HF patients. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Data on 1177 heart failure patients were analysed. METHODS Patients meeting the inclusion criteria were identified from the MIMIC-III database and randomly divided into derivation (n=825, 70%) and a validation (n=352, 30%) group. Independent risk factors for in-hospital mortality were screened using the extreme gradient boosting (XGBoost) and the least absolute shrinkage and selection operator (LASSO) regression models in the derivation sample. Multivariate logistic regression analysis was used to build prediction models in derivation group, and then validated in validation cohort. Discrimination, calibration and clinical usefulness of the predicting model were assessed using the C-index, calibration plot and decision curve analysis. After pairwise comparison, the best performing model was chosen to build a nomogram according to the regression coefficients. RESULTS Among the 1177 admissions, in-hospital mortality was 13.52%. In both groups, the XGBoost, LASSO regression and Get With the Guidelines-Heart Failure (GWTG-HF) risk score models showed acceptable discrimination. The XGBoost and LASSO regression models also showed good calibration. In pairwise comparison, the prediction effectiveness was higher with the XGBoost and LASSO regression models than with the GWTG-HF risk score model (p<0.05). The XGBoost model was chosen as our final model for its more concise and wider net benefit threshold probability range and was presented as the nomogram. CONCLUSIONS Our nomogram enabled good prediction of in-hospital mortality in ICU-admitted HF patients, which may help clinical decision-making for such patients.
Collapse
Affiliation(s)
- Fuhai Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Xin
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jidong Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingqiang Fu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
9
|
Schultz MA, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Douthit BJ, Forbes T, Gao G, Lee MA, Lekan D, Wieben A, Jeffery AD. Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes: The 2019 Literature Year in Review. Comput Inform Nurs 2021; 39:654-667. [PMID: 34747890 PMCID: PMC8578863 DOI: 10.1097/cin.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science's ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploration.
Collapse
Affiliation(s)
- Mary Anne Schultz
- Author Affiliations: California State University (Dr Schultz); Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University (Ms Walden); Department of Emergency Medicine, Columbia University School of Nursing (Dr Cato); Grand Valley State University (Dr Coviak); Global Health Technology & Informatics, Chevron, San Ramon, CA (Mr Cruz); Saint Camillus International University of Health Sciences, Rome, Italy (Dr D'Agostino); Duke University School of Nursing (Mr Douthit); East Carolina University College of Nursing (Dr Forbes); St Catherine University Department of Nursing (Dr Gao); Texas Woman's University College of Nursing (Dr Lee); Assistant Professor, University of North Carolina at Greensboro School of Nursing (Dr Lekan); University of Wisconsin School of Nursing (Ms Wieben); and Vanderbilt University School of Nursing, and Tennessee Valley Healthcare System, US Department of Veterans Affairs (Dr Jeffery)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
El Iskandarani M, El Kurdi B, Murtaza G, Paul TK, Refaat MM. Prognostic role of albumin level in heart failure: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24785. [PMID: 33725833 PMCID: PMC7969328 DOI: 10.1097/md.0000000000024785] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient. METHODS Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias. RESULTS A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval [CI] 28.4%-37.4%) HF patients with marked heterogeneity (I2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96-7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36-1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05-2.91; I2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67-0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients. CONCLUSION Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.
Collapse
Affiliation(s)
| | | | - Ghulam Murtaza
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Timir K. Paul
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Marwan M. Refaat
- Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| |
Collapse
|
11
|
Okere AN, Sanogo V, Alqhtani H, Diaby V. Identification of risk factors of 30-day readmission and 180-day in-hospital mortality, and its corresponding relative importance in patients with Ischemic heart disease: a machine learning approach. Expert Rev Pharmacoecon Outcomes Res 2020; 21:1043-1048. [PMID: 33131344 DOI: 10.1080/14737167.2021.1842200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: The primary objective of this study is to identify non-laboratory predictors for 30-day hospital readmission and 180-day in-hospital mortality rates among patients hospitalized with ischemic heart disease (IHD).Research design and methods: This is a retrospective cohort study of hospitalized patients (≥ 40 years) with a primary diagnosis of IHD. Data were extracted from the Florida Agency for Health Care Administration dataset from 2006 to 2016. A machine learning approach was used to identify predictors of 30-day hospital readmission and 180-day in-hospital mortality.Results: 346,390 patient records for incident IHD cases were identified. The top two predictors of 30-day readmission were the length of stay and the Elixhauser comorbidity index for readmission [ECI] (Area Under the Curve [AUC]=88%) using decision tree algorithms. For in-hospital mortality, the top two predictors were LOS and ECI (AUC=92%) using gradient boosting regressors. The cumulative 30-day readmission and the 180-day probability of mortality rates were 9.82% and 4.6% respectively.Conclusions: Risk factors of 30-day readmission and 180-day mortality in hospitalized IHD patients identified by machine learning and their relative importance (value) will help pharmacists and other health care providers to prioritize their disease management strategies as they improve the care provided to IHD patients.
Collapse
Affiliation(s)
- Arinze Nkemdirim Okere
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Tallahassee, FL, USA
| | - Vassiki Sanogo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States
| | - Hussain Alqhtani
- Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran, Kingdom of Saudi Arabia.,Department of Pharmaceutical Outcomes and Policy (POP), University of Florida, College of Pharmacy, Gainesville, FL, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy (POP), University of Florida, College of Pharmacy, Gainesville, FL, USA
| |
Collapse
|
12
|
Wang N, Farrell M, Hales S, Hanvey K, Robertson G, Sharp P, Tofler G. Prevalence and seasonal variation of precipitants of heart failure hospitalization and risk of readmission. Int J Cardiol 2020; 316:152-160. [PMID: 32360644 DOI: 10.1016/j.ijcard.2020.04.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
AIMS To determine the prevalence and seasonal variation in precipitants of heart failure (HF) hospitalization and the risk of subsequent HF hospitalizations. METHODS We analysed the characteristics and outcomes of patients hospitalized with HF and enrolled in the Management of Cardiac Failure program in Sydney, Australia. Potential precipitants of HF hospitalization were identified, and Cox-regression analyses performed according to the precipitant. RESULTS Among 6918 patients hospitalized with HF, 5384 (78%) had identified one or more precipitating factors leading to the hospitalization and 3648 (53%) had a single identifiable precipitant. Most precipitants were due to one or more of five prespecified causes - infection (n = 2014), ischemia (n = 1781), arrhythmia (n = 1724), medication related (n = 925) and diet non-compliance (n = 408). All precipitants were more common during winter (p < 0.001), especially infection related precipitants, of which 36% occurred during winter. Among patients with a single identifiable precipitant, one-year risk for HF readmission was lower when the precipitant was arrhythmia (16%) or infection (17%) than when the precipitant was ischemia (21%), dietary non-compliance (23%) or medication related (25%). The precipitant for HF rehospitalizations were more likely to be the same precipitant for the initial admission: infection vs no infection (HR 1.51, 95% CI 1.08-2.13), ischemia vs no ischemia (HR 2.79, 95% CI 1.83-4.25), arrhythmia vs no arrhythmia (HR 3.31, 95% CI 1.87-5.88) and medication related vs not medication related (HR 2.28, 95% CI 1.39-3.74). CONCLUSION The precipitant of HF hospitalization influences the risk and precipitant of subsequent HF hospitalizations. Identifying and targeting interventions towards the precipitating factor may be an important strategy to prevent future HF hospitalizations.
Collapse
Affiliation(s)
- Nelson Wang
- Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | | | | | | | | | | | - Geoffrey Tofler
- Sydney Medical School, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia.
| |
Collapse
|
13
|
Landicho JA, Esichaikul V, Sasil RM. Comparison of predictive models for hospital readmission of heart failure patients with cost-sensitive approach. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1797334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Junar Arciete Landicho
- Department of Information and Communication Technologies, Asian Institute of Technology, Pathumthani, Thailand
- Department of Information Technology, University of Science and Technology of Southern Philippines, Cagayan de Oro City, Philippines
| | - Vatcharaporn Esichaikul
- Department of Information and Communication Technologies, Asian Institute of Technology, Pathumthani, Thailand
| | - Roy Magdugo Sasil
- Department of Internal Medicine, Northern Mindanao Medical Center, Cagayan de Oro City, Philippines
| |
Collapse
|
14
|
Factors Associated With Predischarge Versus Postdischarge Scheduling for Early Follow-up Appointments. J Cardiovasc Nurs 2020; 36:151-156. [PMID: 32398502 DOI: 10.1097/jcn.0000000000000685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Per national guidelines, early follow-up appointments should be scheduled before discharge, but in previous research, appointments scheduled before discharge were not associated with appointment adherence. OBJECTIVES The purpose of this study was to determine whether patient, heart failure (HF), and hospital factors were associated with predischarge appointment scheduling. METHODS A secondary analysis of a medical record review included patients hospitalized for decompensated HF at 3 health system hospitals who had a scheduled office appointment post discharge at 14 days or less. Patient demographics, and social, HF, and hospital factors were studied for association with predischarge scheduling. RESULTS In multivariable modeling, the odds of having an appointment scheduled predischarge were based on 3 factors: nonwhite race, history of chronic renal insufficiency, and no admission within 14 days before HF hospitalization. CONCLUSIONS Appointment scheduling may be based on provider perceptions of readmission risk. Follow-up appointment scheduling practices should be based on systematic processes.
Collapse
|
15
|
Rate of Rehospitalization in 60 Days of Discharge and It's Determinants in Patients with Heart Failure with Reduced Ejection Fraction in a Tertiary Care Centre in India. INTERNATIONAL JOURNAL OF HEART FAILURE 2020; 2:131-144. [PMID: 36263288 PMCID: PMC9536659 DOI: 10.36628/ijhf.2020.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives Identifying the patients with acute heart failure (HF) at high risk for rehospitalization after hospital discharge will enable proper optimization of treatment. This study is aimed to evaluate the rehospitalization rate at 60 days of discharge and their predictors in patients of chronic heart failure with reduced ejection fraction (HFrEF). Methods This prospective observational study enrolled patients with left ventricle ejection fraction (LVEF) <40%, who were admitted because of acute decompensation. Patients were followed for 60 days to analyze rehospitalization rate and its predictors. Results Of 103 HFrEF patients (74% male; mean age 55.8 years) enrolled, 7 patients died during index admission and 3 patients lost to follow up. The 60-day rehospitalization rate was 37% (34/93). We studied 23 clinical and 9 biochemical predictors of rehospitalization. Out of 34 events of rehospitalization, 79.41% (n=28) was due to cardiac cause followed by respiratory 5.8% (n=2), renal 5.8% (n=2) and others 5.8% (n=2). Among all the parameters, on logistic regression analysis having longer length of index hospital stay (>7 days) (52.8% vs. 28.8%; odds ratio [OR], 1.79; confidence interval [CI], 1.2–7.25; p=0.040) and chronic kidney disease (CKD) (26.5% vs. 8.5%; OR, 3.06; CI, 1.1–57.04; p=0.050) independently increased the risk of rehospitalization at 60 days of discharge. Further higher haemoglobin level (11.3 vs. 9.9 gm/dL; OR, 0.71; CI, 0.48–0.97; p=0.050) and higher LVEF at index admission (30.4% vs. 26.5%; OR, 0.87; CI, 0.75–0.99; p=0.049) were associated with decreased the risk of rehospitalization. Conclusions Our study reveals that patients with HFrEF have significantly higher rehospitalization rate (37%) and in-hospital mortality rates (6.78%) of any chronic cardiac disease conditions. Correction of low hemoglobin and special care in those who are having very low LVEF, CKD and longer length of stay, including tailored therapy and frequent visits may play an important role in preventing future rehospitalization in these patients.
Collapse
|
16
|
Al-Omary MS, Mcivor D, Sverdlov AL. Predicting Events in Heart Failure Patients: An Ongoing Challenge. Heart Lung Circ 2019; 28:195-197. [PMID: 30654943 DOI: 10.1016/j.hlc.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mohammed S Al-Omary
- The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn Mcivor
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Aaron L Sverdlov
- The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
| |
Collapse
|
17
|
Go YY, Sellmair R, Allen JC, Sahlén A, Bulluck H, Sim D, Jaufeerally FR, MacDonald MR, Lim ZY, Chai P, Loh SY, Yap J, Lam CSP. Defining a 'frequent admitter' phenotype among patients with repeat heart failure admissions. Eur J Heart Fail 2018; 21:311-318. [PMID: 30549171 DOI: 10.1002/ejhf.1348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS We aimed to identify a 'frequent admitter' phenotype among patients admitted for acute decompensated heart failure (HF). METHODS AND RESULTS We studied 10 363 patients in a population-based prospective HF registry (2008-2012), segregated into clusters based on their 3-year HF readmission frequency trajectories. Using receiver-operating characteristic analysis, we identified the index year readmission frequency threshold that most accurately predicts HF admission frequency clusters. Two clusters of HF patients were identified: a high frequency cluster (90.9%, mean 2.35 ± 3.68 admissions/year) and a low frequency cluster (9.1%, mean 0.50 ± 0.81 admission/year). An index year threshold of two admissions was optimal for distinguishing between clusters. Based on this threshold, 'frequent admitters', defined as patients with ≥ 2 HF admissions in the index year (n = 2587), were of younger age (68 ± 13 vs 69 ± 13 years), more often male (58% vs. 54%), smokers (38.4% vs. 34.4%) and had lower left ventricular ejection fraction (37 ± 17 vs. 41 ± 17%) compared to 'non-frequent admitters' (< 2 HF admissions in the index year; n = 7776) (all P < 0.001). Despite similar rates of advanced care utilization, frequent admitters had longer length of stay (median 4.3 vs. 4.0 days), higher annual inpatient costs (€ 7015 vs. € 2967) and higher all-cause mortality at 3 years compared to the non-frequent admitters (adjusted odds ratio 2.33, 95% confidence interval 2.11-2.58; P < 0.001). CONCLUSION 'Frequent admitters' have distinct clinical characteristics and worse outcomes compared to non-frequent admitters. This study may provide a means of anticipating the HF readmission burden and thereby aid in healthcare resource distribution relative to the HF admission frequency phenotype.
Collapse
Affiliation(s)
- Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Reinhard Sellmair
- Chair of Renewable and Sustainable Energy Systems, Technische Universität München, München, Germany
| | - John C Allen
- Duke-National University of Singapore Graduate Medical School, Singapore
| | - Anders Sahlén
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore.,Karolinska Institutet, Stockholm, Sweden
| | | | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Fazlur R Jaufeerally
- Duke-National University of Singapore Graduate Medical School, Singapore.,Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | - Zhan Yun Lim
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - Ping Chai
- Department of Cardiology, National University Hospital, Singapore
| | - Seet Yoong Loh
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Jonathan Yap
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Carolyn S P Lam
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| |
Collapse
|
18
|
Thomas MC. Perspective Review: Type 2 Diabetes and Readmission for Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818779588. [PMID: 29899670 PMCID: PMC5992798 DOI: 10.1177/1179546818779588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.
Collapse
Affiliation(s)
- Merlin C Thomas
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
19
|
Shah SR, Winchester DE. The impact of chronic kidney disease on medication choice and pharmacologic management in patients with heart failure. Expert Rev Clin Pharmacol 2018; 11:571-579. [DOI: 10.1080/17512433.2018.1479252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Syed Raza Shah
- Department of Internal Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|