Seasonality and Readmission after Heart Failure, Myocardial Infarction, and Pneumonia

Prevalence of coronary artery disease and its risk factors in Majmaah City, Kingdom of Saudi Arabia

Objective

This study was carried out with an aim to outline the prevalence of coronary artery diseases, its risk of one region of the Saudi Arabia.

Methods

A retrospective observational study conducted across five secondary medical centers located in the city of Majmaah. Hospital medical records and ministry of health records were screened over a 6-month period for data on patients admitted for Coronary artery disease (CAD). Data collected included sociodemographic characteristics, medical profile, and laboratory findings.

Results

A total of 327 participants were included in this study with a median age of 64 and the majority being male participants (59.8%). The majority were married, held a primary school degree and earned a salary for living. A large number (82.9%) were hypertensive and diabetic (66.7%) and one-fourth had a previous MI (25.1%). A large number (73.7%) had heart failure with a mean ejection fraction of 44% (SD = 13). The causes of heart failure were mainly ischemic (56.3%) and hypertensive (28.1%). Readmission rates at 30 and 90 days then at 6 and 12 months were 22, 53.8, 68.8, and 75.8%, respectively. The mortality rates at the same time intervals were 5.5, 8.9, 14.1, and 22.9%, respectively. Predictors of readmission are age, CCI, and NYHA class.

Conclusion

Coronary artery disease is the leading cause of heart failure. End stage CAD can have similar results in terms of readmission and mortality as heart failure. Future research should target patients in different stages of the condition and monitor their comorbidities which may impact the study findings.

Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting

Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.

Ninety-Day Readmission After Open Surgical Repair of Stanford Type A Aortic Dissection

BACKGROUND

Investigations into readmissions after surgical repair of acute Stanford Type A aortic dissection (TAAD) remain scarce. We analyzed potential risk factors for readmission after TAAD.

METHODS

The 2013-2014 United States Nationwide Readmissions Database was queried for TAAD index hospitalizations and 90-day readmissions indicated by diagnostic and procedural codes. Multivariable analysis was completed to identify risk factors and the most common reasons for readmission.

RESULTS

We identified 6,975 patients (65% male; age, 60.0±0.4 years) who underwent surgical repair for TAAD. Overall, 2,062 patients (29.6%) were readmitted within 90 days: 634 (30.7%) during the first 30 days, and 1,428 (69.3%) during days 31-90. Readmitted patients had a higher prevalence of chronic kidney disease at index admission (18.0% vs 11.6%, P=.002), greater overall index length of stay (17.8±0.6 vs 15.5±0.4 days; P=.0003), and greater index hospitalization cost ($90,637±$2,691 vs $80,082±$2,091; P=.0003). Mortality during readmission was 3.6% (n=74). Indications for readmission were most commonly cardiac (26.2%), infectious (17.8%), and pulmonary (11.7%). Multivariable analysis identified 2 independent risk factors for readmission: acute kidney injury (OR 1.49; 95% CI 1.24-1.78, P<.0001) and an Elixhauser Comorbidity Index >4 (OR 1.26; 95% CI 1.06-1.49, P=.009).

CONCLUSIONS

After surgical repair of TAAD, approximately 30% of patients were readmitted within 90 days, two thirds of them during the 31- to 90-day period. Targeted improvements in perioperative care and post-discharge follow-up of patients with multiple comorbidities could mitigate readmission rates. Efforts to reduce readmissions should be continued throughout the 90-day period.

Factors Associated with In-Hospital Mortality in Acute Care Hospital Settings: A Prospective Observational Study

Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as nursing workload or the level of dependency, are being incorporated. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. Methods: A multicentre prospective observational study design was used. Sampling was conducted between February 2015 and October 2017. Patients over 16 years, admitted to medical or surgical units at 11 public hospitals in Andalusia (Spain), with a foreseeable stay of at least 48 h were included. Multivariate regression analyses were performed to analyse the data. Results: The sample consisted of 3821 assessments conducted in 1004 patients. The mean profile was that of a male (52%), mean age of 64.5 years old, admitted to a medical unit (56.5%), with an informal caregiver (60%). In-hospital mortality was 4%. The INICIARE (Inventario del Nivel de Cuidados Mediante Indicadores de Clasificación de Resultados de Enfermería) scale yielded an adjusted odds ratio [AOR] of 0.987 (95% confidence interval [CI]: 0.97–0.99) and the nurse staffing level (NSL) yielded an AOR of 1.197 (95% CI: 1.02–1.4). Conclusion: Nursing care dependency measured by INICIARE and nurse staffing level was associated with in-hospital mortality.

Readmissions After Acute Myocardial Infarction: How Often Do Patients Return to the Discharging Hospital?

Background

When patients require readmission after a recent myocardial infarction (MI), returning to the discharging (index) hospital may be associated with better outcomes as a result of greater continuity in care. However, little evidence exists to answer this frequent patient question.

Methods and Results

Among Medicare patients aged ≥65 years discharged home alive post‐MI from 491 US hospitals in the ACTION (Acute Coronary Treatment Intervention Outcomes Network) Registry, we compared reason for readmission, duration of rehospitalization, and 30‐day mortality between patients readmitted to the index versus nonindex hospital within 30 days of index MI discharge. Among 53 471 MI patients, 7715 (14%) were readmitted within 30 days, and most readmitted patients (73%) returned to the discharging hospital. Reason for readmission was not significantly associated with location of readmission. In multivariable modeling, the strongest factors associated with readmission to a nonindex hospital were distance from the discharging hospital, transfer‐in during the index MI hospitalization, and frequency of nonindex hospital admissions in the year preceding to the index MI. Duration of rehospitalization did not differ significantly between patients readmitted to the index versus nonindex hospital (median, 4 versus 3 days; P=0.17). Mortality risk was also not significantly different between patients readmitted to the index versus nonindex hospital overall (7.4 versus 7.7%; adjusted odds ratio, 0.89; 95% CI, 0.73–1.10) and when stratified by reason for readmission (P for interaction=0.61).

Conclusions

Post‐MI readmissions did not differ in reason for readmission, duration of rehospitalization, or associated mortality when compared between patients who returned to the discharging hospital and those who sought care elsewhere.