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Elola J, Fernández-Pérez C, Del Prado N, Bernal JL, Rosillo N, Bas M, Fernández-Ortiz A, Barba R, Carretero-Gómez J, Pérez-Villacastín J. Weekend and holiday admissions for decompensated heart failure and in-hospital mortality. A cumulative effect of "nonworking" days? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:440-447. [PMID: 37977280 DOI: 10.1016/j.rec.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyze whether nonelective admissions in patients with heart failure (HF) on nonworking days (NWD) are associated with higher in-hospital mortality. METHODS We conducted a retrospective (2018-2019) observational study of episodes of nonelective admissions in patients aged 18 years and older discharged with a principal diagnosis of HF in acute general hospitals of the Spanish National Health System. NWD at admission were defined as Fridays after 14:00hours, Saturdays, Sundays, and national and regional holidays. In-hospital mortality was analyzed with logistic regression models. The length of NWD was considered as an independent continuous variable. Propensity score matching was used as a sensitivity analysis. RESULTS We selected 235 281 episodes of nonelective HF admissions. When the NWD periods were included in the in-hospital mortality model, the increases in in-hospital mortality compared with weekday admission were as follows: 1 NWD day (OR, 1.11; 95%CI, 1.07-1.16); 2 days (OR, 1.13; 95%CI, 1.09-1.17); 3 (OR, 1.16; 95%CI, 1.05-1.27); and ≥4 days (OR, 1.20; 95%CI, 1.09-1.32). There was a statistically significant association between a linear increase in NWD and higher risk-adjusted in-hospital mortality (chi-square trend P=.0002). After propensity score matching, patients with HF admitted on NWD had higher in-hospital mortality than those admitted on weekdays (OR, 1.11; average treatment effect, 12.2% vs 11.1%; P<.001). CONCLUSIONS We found an association between admissions for decompensated HF on an NWD and higher in-hospital mortality. The excess mortality is likely not explained by differences in severity. In this study, the "weekend effect" tended to increase as the NWD period became longer.
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Affiliation(s)
- Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, Spain; Instituto de Investigación de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Información y control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marian Bas
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Raquel Barba
- Servicio de Medicina Interna, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | - Julián Pérez-Villacastín
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain. https://twitter.com/@jvillacastin
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Wong EK, Demers C. The "Weekend Effect" in Patients Admitted With Heart Failure: An Important Gap in Care? J Card Fail 2023; 29:1367-1368. [PMID: 37648060 DOI: 10.1016/j.cardfail.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Eric Kc Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Demers
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Lin MS, Wang PC, Lin MH, Kuo TY, Lin YS, Chen TH, Tsai MH, Yang YH, Lin CL, Chung CM, Chu PH. Acute heart failure with mildly reduced ejection fraction and myocardial infarction: a multi-institutional cohort study. BMC Cardiovasc Disord 2023; 23:272. [PMID: 37221514 DOI: 10.1186/s12872-023-03286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Little research has been done on ischemic outcomes related to left ventricular ejection fraction (EF) in acute decompensated heart failure (ADHF). METHODS A retrospective cohort study was conducted between 2001 and 2021 using the Chang Gung Research Database. ADHF Patients discharged from hospitals between January 1, 2005, and December 31, 2019. Cardiovascular (CV) mortality and heart failure (HF) rehospitalization are the primary outcome components, along with all-cause mortality, acute myocardial infarction (AMI) and stroke. RESULTS A total of 12,852 ADHF patients were identified, of whom 2,222 (17.3%) had HFmrEF, the mean (SD) age was 68.5 (14.6) years, and 1,327 (59.7%) were males. In comparison with HFrEF and HFpEF patients, HFmrEF patients had a significant phenotype comorbid with diabetes, dyslipidemia, and ischemic heart disease. Patients with HFmrEF were more likely to experience renal failure, dialysis, and replacement. Both HFmrEF and HFrEF had similar rates of cardioversion and coronary interventions. There was an intermediate clinical outcome between HFpEF and HFrEF, but HFmrEF had the highest rate of AMI (HFpEF, 9.3%; HFmrEF, 13.6%; HFrEF, 9.9%). The AMI rates in HFmrEF were higher than those in HFpEF (AHR, 1.15; 95% Confidence Interval, 0.99 to 1.32) but not in HFrEF (AHR, 0.99; 95% Confidence Interval, 0.87 to 1.13). CONCLUSION Acute decompression in patients with HFmrEF increases the risk of myocardial infarction. The relationship between HFmrEF and ischemic cardiomyopathy, as well as optimal anti-ischemic treatment, requires further research on a large scale.
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Affiliation(s)
- Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Po-Chang Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Keelung, Taiwan
| | - Ming-Horng Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Chang-Min Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, No.5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital Chang Gung University College of Medicine, Taipei, Taiwan.
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Li Y, Cai Z, She Y, Shen W, Wang T, Luo L. Development and validation of a nomogram for predicting atrial fibrillation in patients with acute heart failure admitted to the ICU: a retrospective cohort study. BMC Cardiovasc Disord 2022; 22:528. [PMID: 36474152 PMCID: PMC9724334 DOI: 10.1186/s12872-022-02973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Acute heart failure is a serious condition. Atrial fibrillation is the most frequent arrhythmia in patients with acute heart failure. The occurrence of atrial fibrillation in heart failure patients worsens their prognosis and leads to a substantial increase in treatment costs. There is no tool that can effectively predict the onset of atrial fibrillation in patients with acute heart failure in the ICU currently. MATERIALS AND METHODS We retrospectively analyzed the MIMIC-IV database of patients admitted to the intensive care unit (ICU) for acute heart failure and who were initially sinus rhythm. Data on demographics, comorbidities, laboratory findings, vital signs, and treatment were extracted. The cohort was divided into a training set and a validation set. Variables selected by LASSO regression and multivariate logistic regression in the training set were used to develop a model for predicting the occurrence of atrial fibrillation in acute heart failure in the ICU. A nomogram was drawn and an online calculator was developed. The discrimination and calibration of the model was evaluated. The performance of the model was tested using the validation set. RESULTS This study included 2342 patients with acute heart failure, 646 of whom developed atrial fibrillation during their ICU stay. Using LASSO and multiple logistic regression, we selected six significant variables: age, prothrombin time, heart rate, use of vasoactive drugs within 24 h, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology Score (APS) III. The C-index of the model was 0.700 (95% CI 0.672-0.727) and 0.682 (95% CI 0.639-0.725) in the training and validation sets, respectively. The calibration curves also performed well in both sets. CONCLUSION We developed a simple and effective model for predicting atrial fibrillation in patients with acute heart failure in the ICU.
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Affiliation(s)
- Yide Li
- grid.511083.e0000 0004 7671 2506Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Zhixiong Cai
- grid.452734.3Department of Cardiology, Shantou Central Hospital, Shantou, China
| | - Yingfang She
- grid.511083.e0000 0004 7671 2506Neurology Medicine Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wenjuan Shen
- grid.511083.e0000 0004 7671 2506Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Tinghuai Wang
- grid.12981.330000 0001 2360 039XDepartment of Physiology, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Liang Luo
- grid.511083.e0000 0004 7671 2506Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, Zheng Q, Zhou J, Liu YZ, Liu L, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovasc Disord 2022; 22:307. [PMID: 35799104 PMCID: PMC9264535 DOI: 10.1186/s12872-022-02743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei province, China
| | - Xiao-Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Ying-Hua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Sen-Lin Li
- Department of Cardiology, Zhangjiakou First Hospital, Zhangjiakou, 075000, Hebei Province, China
| | - Qi Zhang
- Department of Cardiology, Baoding First Central Hospital, Baoding, 071000, Hebei Province, China
| | - Wei-Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei Province, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, 053000, Hebei Province, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, 067024, Hebei Province, China
| | - Yong-Zheng Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Li Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061011, Hebei Province, China
| | - Hong-Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, 056000, Hebei Province, China
| | - Qing-Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, 054001, Hebei Province, China
| | - Xi-Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, China
| | - Ying-Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, 071000, Hebei Province, China
| | - Xue Geng
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Qian Wang
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Wei Cui
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.
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Joseph S, Panniyammakal J, Abdullakutty J, S S, Vaikathuseril L J, Joseph J, Mattummal S, Punnose E, Unni G, Natesan S, Sivadasanpillai H. The Cardiology Society of India-Kerala Acute Heart Failure Registry: poor adherence to guideline-directed medical therapy. Eur Heart J 2021:ehab793. [PMID: 34931232 DOI: 10.1093/eurheartj/ehab793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 11/03/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS Data on the burden of acute heart failure (AHF) admissions, practice patterns, and outcomes are rare from India and other low- and middle-income countries. We aimed to describe the baseline characteristics, guideline-directed medical therapy (GDMT) prescribing patterns and 90-day mortality rates in patients admitted with AHF in Kerala, India. METHODS AND RESULTS The Cardiology Society of India-Kerala Acute Heart Failure Registry (CSI-KHFR) is an observational registry from 50 hospitals in Kerala, India, with prospective follow-up. Consecutive patients with AHF, who consented to participate, were enrolled. The 2016 European Society of Cardiology criteria were used for the diagnosis of AHF. Kaplan-Meier survival analysis and Cox-proportional hazard models were used for data analysis. The variables in the MAGGIC risk score were used in the multivariable model. A total of 7507 patients with AHF (37% female) participated in the CSI-KHFR. The mean age was 64.3 (12.9) years. More than two-third had reduced ejection fraction (EF) (67.5%). Nearly one-fourth (28%) of patients with heart failure (HF) with reduced EF received GDMT. Overall, in-hospital and 90-day mortality rates were 7% and 11.6%, respectively. Prescriptions of different components of GDMT were independently associated with 90-day mortality. CONCLUSION The CSI-KHFR recorded an in-hospital and 90-day mortality of 7% and 11.6%, respectively. Only one of four patients received GDMT. AHF mortality was independently associated with GDMT initiation. Quality improvement initiatives that focus on increasing GDMT prescription may improve the survival of HF patients in India.
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Affiliation(s)
- Stigi Joseph
- Department of Cardiology, Little Flower Hospital and Research Centre, Angamaly, Ernakulam, Kerala 683572, India
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Chiou LJ, Chen HM, Pan LF, Lee CC. Holiday ratio of hospitalization and 30-day readmission rates among cancer patients after major surgery. Cancer Med 2021; 11:743-752. [PMID: 34904394 PMCID: PMC8817097 DOI: 10.1002/cam4.4482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 10/16/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background To determine the association of 30‐day readmission with weekend discharge and the number of holiday days during a hospital stay (holiday ratio). Methods This retrospective cohort study used the clinical research database and cancer registry data of our hospital from January 1, 2011 to December 31, 2017. Patient characteristics, tumor factors, clinical laboratory data, and proxies of continuity of care, such as weekend discharge or holiday ratio (holiday days/total hospitalization days), received statistical analysis. Multivariate logistic regression identified the independent factors for 30‐day potentially avoidable readmission rate (PAR). Results Of 1433 patients receiving tumor resection, 520 (36.29%) had colon cancer; 440 (30.70%) had head and neck cancer (HNC), and 473 (33.01%) had other cancers (lung, liver, and prostate). The rate of 30‐day PAR was 6.3% for those with colon cancer, 8.6% for HNC, and 3.6% for other cancers. The 30‐day PAR did not significantly differ by discharge on a weekend versus weekday for those with colon cancer (8.33% vs. 5.90%; p = 0.379), HNC (7.06% vs. 9.01%; p = 0.566), or other cancers (0.00% vs. 4.28%; p = 0.960). Colon cancer patients with holiday ratio >0.3 had a higher readmission rate (9.58% vs. 4.82%, p = 0.041). In multivariate analysis, a holiday ratio >0.3 (adjusted odds ratio 2.16; 95% Confidence Interval, 1.05–4.39) in those with colon cancer was an independent predictor of 30‐day PAR. Conclusions Weekend discharge after major surgery did not affect 30‐day readmission rates in cancer patients, but the holiday ratio did affect 30‐day PAR for those with colon cancer.
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Affiliation(s)
- Ling-Jan Chiou
- Department of Health Business Administration, Department of Nursing, and Department of Oral Hygiene, Meiho University, Pingtung, Taiwan
| | - Hsiu-Min Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Li-Fei Pan
- Department of Medical Affair Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chao Tung University, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Scrutinio D, Guida P, Passantino A, Scalvini S, Bussotti M, Forni G, Vaninetti R, La Rovere MT. Characteristics, outcomes and long-term survival of heart failure patients undergoing inpatient cardiac rehabilitation. Arch Phys Med Rehabil 2021; 103:891-898.e4. [PMID: 34740595 DOI: 10.1016/j.apmr.2021.10.014] [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] [Received: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association of CR participation with all-cause mortality after a hospitalization for HF and to describe the characteristics and functional and clinical outcomes of heart failure (HF) patients undergoing inpatient cardiac rehabilitation (CR). DESIGN Multicenter cohort study. The association between CR participation and all-cause mortality from discharge from the acute care setting was assessed using Cox regression analysis adjusting for established prognostic factors. SETTING Six inpatients rehabilitation facilities (IRF). PARTICIPANTS 3,219 HF patients admitted to inpatient CR between January 2013 and December 2016. Of these patients, 1,455 had been transferred directly from acute care hospitals after a hospitalization for HF (CR-Group 1) and 1,764 had been admitted from the community due to worsening functional disability or worsening clinical conditions (CR-Group 2). Six hundred thirty-three patients not referred to CR after a hospitalization for HF served as control group (non-CR Group). INTERVENTION Cardiac rehabilitation. MAIN OUTCOME MEASURE long-term mortality. Secondary outcomes were: 1. Change in functional capacity, as assessed by change in 6-minute walking distance (6MWD) from admission to discharge; 2. Clinical outcomes of the index inpatient rehabilitation admission, including in-hospital mortality and unplanned (re)admission to the acute care. RESULTS Compared with the non-CR Group, the adjusted hazard ratios of mortality at 1, 3, and 5 years for CR-Group 1 patients were 0.82 (0.68-0.97), 0.81 (0.71-0.93), and 0.80 (0.70-0.91). 6MWD increased from 230 to 292 m (p<.001) and 43.4% of the patients gained >50 m improvement. Overall, 2.5% of the patients died in hospital and 4.7% of the patients experienced unplanned (re)admissions to acute care, with significant differences between Group 1 and Group 2. CONCLUSIONS Our data show that inpatient CR is effective in improving functional capacity and suggest that inpatient CR provided in the earliest period following a hospitalization for HF is associated with long-term improved survival.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Lumezzane, Brescia, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Milano-Camaldoli, Milano, Italy
| | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Pavia, Pavia, Italy
| | - Raffaella Vaninetti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Tradate, Varese, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Montescano, Pavia, Italy
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Meng N, Ye Z, Liu Y, Qin C, Su Y. Impact of the 'weekend effect' on hospital-acquired pneumonia after aneurysmal subarachnoid hemorrhage. Postgrad Med 2021; 133:974-978. [PMID: 34323649 DOI: 10.1080/00325481.2021.1959936] [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: 10/20/2022]
Abstract
OBJECTIVES Weekend admission has been reported to be associated with poor clinical outcomes of various diseases. This study aimed to determine whether weekend admission increases the incidence of hospital-acquired pneumonia (HAP) in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We retrospectively analyzed aSAH patients admitted to our hospital between 2014 and 2020. These patients were divided into weekend and weekday groups. We compared the incidence of HAP and other clinical outcomes between the two groups. Risk factors for HAP were identified by logistic regression analysis. RESULTS Of 653 included aSAH patients, 145 (22%) were admitted on weekends and 508 (78%) were admitted on weekdays. The incidence of HAP in the weekend group was significantly higher than that in the weekday group (25% vs 16%, P = 0.01). The weekend group showed worse clinical outcomes, including worse neurological outcome (74% vs 65%, P = 0.03), higher risk of intensive care unit (ICU) admission (21% vs 13%, P = 0.01) and longer length of stay (21.3 vs 16.4 days, P < 0.01). Age ≥ 60 years (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3-3.0, P < 0.01), modified Fisher score (MFS) ≥ 3 (OR = 1.7, 95% CI = 1.1-2.6, P = 0.02), weekend admission (OR = 1.8, 95% CI = 1.1-2.8, P = 0.02) and operative treatment (OR = 2.3, 95% CI = 1.2-4.5, P = 0.02) were risk factors for HAP following aSAH. CONCLUSION Weekend admission was associated with a higher incidence of HAP in aSAH patients. This study suggested that medical administrators may need to optimize healthcare services on weekends.
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Affiliation(s)
- Ningqin Meng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ying Liu
- Department of Rehabilitation, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ying Su
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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10
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Harhash AA, Kennedy KF, Fendler TJ, Khumri TM, Nassif ME, Magalski A, Sperry BW. Comparison of Outcomes Among Patients With Cardiogenic Shock Admitted on Weekends Versus Weekdays. Am J Cardiol 2021; 144:20-25. [PMID: 33417875 DOI: 10.1016/j.amjcard.2020.12.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
Cardiogenic shock (CS) is associated with high mortality and often requires involvement of a multidisciplinary provider team to deliver timely care. Care coordination is more difficult on weekends, which may lead to a delay in care. We sought to assess the effect of weekend admissions on outcomes in patients admitted with CS. Patients admitted with CS were identified from 2005 to 2014 in the National Inpatient Sample using ICD9 code 785.51. Baseline demographics, in-hospital procedures, and outcomes were obtained and compared by day of admission. A multivariable model was used to assess the impact of weekend admission on in-hospital mortality. A total of 875,054 CS admissions were identified (age 67.4 ± 15.1 years, 40.2% female, 72.1% Caucasian), with 23% of patients being admitted on weekends. Baseline co-morbidities were similar between groups. Weekend admissions were associated with higher in-hospital mortality (40.6% vs 37.5%) and cardiac arrest (20.3% vs 18.1%, p < 0.001 for both) consistently over the study period. Use of temporary and permanent mechanical support devices and heart transplantation were slightly less common for weekend admissions. In a multivariable model adjusting for relevant confounders, weekend admission was associated with a 10% increased mortality in patients with CS. In conclusion, patients with CS admitted on weekends had higher in-hospital mortality and were slightly less likely to receive mechanical support and advanced therapies compared with those admitted on weekdays. Future studies and health system initiatives should focus on rectifying these disparities with around-the-clock multidisciplinary coordinated care for CS.
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Affiliation(s)
- Ahmed A Harhash
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Timothy J Fendler
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Taiyeb M Khumri
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Michael E Nassif
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Anthony Magalski
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Brett W Sperry
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
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11
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Chiu CY, Oria D, Yangga P, Kang D. Quality assessment of weekend discharge: a systematic review and meta-analysis. Int J Qual Health Care 2020; 32:347-355. [PMID: 32453404 DOI: 10.1093/intqhc/mzaa060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. DATA SOURCES PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. STUDY SELECTION Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. DATA EXTRACTION Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. RESULTS OF DATA SYNTHESIS There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. CONCLUSION In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.
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Affiliation(s)
- Chia-Yu Chiu
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - David Oria
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - Peter Yangga
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - Dasol Kang
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
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12
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Chen WS, Wang CH, Cheng CW, Liu MH, Chu CM, Wu HP, Huang PC, Lin YT, Ko T, Chen WH, Wang HJ, Lee SC, Liang CY. Elevated plasma phenylalanine predicts mortality in critical patients with heart failure. ESC Heart Fail 2020; 7:2884-2893. [PMID: 32618142 PMCID: PMC7524095 DOI: 10.1002/ehf2.12896] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Previous studies found a relationship between elevated phenylalanine levels and poor cardiovascular outcomes. Potential strategies are available to manipulate phenylalanine metabolism. This study investigated whether increased phenylalanine predicted mortality in critical patients with either acute heart failure (HF) or acute on chronic HF, and its correlation with inflammation and immune cytokines. Methods and results This study recruited 152 subjects, including 115 patients with HF admitted for critical conditions and 37 normal controls. We measured left ventricular ejection fraction (LVEF), plasma concentrations of phenylalanine, C‐reactive protein, albumin, pre‐albumin, transferrin, and pro‐inflammatory and immune cytokines. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and maximal vasoactive–inotropic scores (VISmax) were calculated. Patients were followed up until death or a maximum of 1 year. The primary endpoint was all‐cause death. Of the 115 patients, 37 (32.2%) were admitted owing to acute HF, and 78 (67.8%) were admitted owing to acute on chronic HF; 64 (55.7%) had ST elevation/non‐ST elevation myocardial infarction. An LVEF measured during the hospitalization of <40%, 40–50%, and ≥50% was noted in 51 (44.3%), 15 (13.1%), and 49 (42.6%) patients, respectively. During 1 year follow‐up, 51 (44.3%) patients died. Death was associated with higher APACHE II, SOFA, and VISmax scores; higher levels of C‐reactive protein and phenylalanine; higher incidence of atrial fibrillation and use of inotropic agents; lower cholesterol, albumin, pre‐albumin, and transferrin levels; and significant changes in pro‐inflammatory and immune cytokines. Phenylalanine levels demonstrated an area under the receiver operating characteristic curve of 0.80 for mortality, with an optimal cut‐off value set at 112 μM. Phenylalanine ≥ 112 μM was associated with a higher mortality rate than was phenylalanine < 112 μM (80.5% vs. 24.3%, P < 0.001) [hazard ratio = 5.07 (2.83–9.05), P < 0.001]. The Kaplan–Meier curves revealed that phenylalanine ≥ 112 μM was associated with a lower accumulative survival rate (log rank = 36.9, P < 0.001). Higher phenylalanine levels were correlated with higher APACHE II and SOFA scores, higher C‐reactive protein levels and incidence of using inotropic agents, and changes in cytokines suggestive of immunosuppression, but lower levels of pre‐albumin and transferrin. Further multivariable analysis showed that phenylalanine ≥ 112 μM predicted death over 1 year independently of age, APACHE II and SOFA scores, atrial fibrillation, C‐reactive protein, cholesterol, pre‐albumin, transferrin, and interleukin‐8 and interleukin‐10. Conclusions Elevated phenylalanine levels predicted mortality in critical patients, phenotypically predominantly presenting with HF, independently of traditional prognostic factors and cytokines associated with inflammation and immunity.
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Affiliation(s)
- Wei-Siang Chen
- Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Wen Cheng
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Hui Liu
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Ming Chu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Huang-Ping Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Pao-Chin Huang
- Nutrition Department, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yi-Tsen Lin
- Nutrition Department, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ta Ko
- Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Hsin Chen
- Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huei-Jen Wang
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shu-Chiu Lee
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chung-Yu Liang
- Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
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13
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Mehta A, Pandey A. Taking a Day Off in the Care of Patients With Acute Decompensated Heart Failure: The Weekend Effect. J Am Heart Assoc 2019; 8:e013393. [PMID: 31319736 PMCID: PMC6761670 DOI: 10.1161/jaha.119.013393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
See Article Mounsey et al
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Ambarish Pandey
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
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14
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Mounsey LA, Chang PP, Sueta CA, Matsushita K, Russell SD, Caughey MC. In-Hospital and Postdischarge Mortality Among Patients With Acute Decompensated Heart Failure Hospitalizations Ending on the Weekend Versus Weekday: The ARIC Study Community Surveillance. J Am Heart Assoc 2019; 8:e011631. [PMID: 31319746 PMCID: PMC6761634 DOI: 10.1161/jaha.118.011631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Hospital staffing is usually reduced on weekends, potentially impacting inpatient care and postdischarge coordination of care for patients with acute decompensated heart failure (ADHF). However, investigations of in‐hospital mortality on the weekend versus weekday, and post‐hospital outcomes of weekend versus weekday discharge are scarce. Methods and Results Hospitalizations for ADHF were sampled by stratified design from 4 US areas by the Community Surveillance component of the ARIC (Atherosclerosis Risk in Communities) study. ADHF was classified by a standardized computer algorithm and physician review of the medical records. Discharges or deaths on Saturday, Sunday, or national holidays were considered to occur on the “weekend.” In‐hospital mortality was compared between hospitalizations ending on a weekend versus weekday. Post‐hospital (28‐day) mortality was compared among patients discharged alive on a weekend versus weekday. From 2005 to 2014, 39 699 weighted ADHF hospitalizations were identified (19% terminating on a weekend). Demographics, comorbidities, length of stay, and guideline‐directed therapies were similar for patients with hospitalizations ending on a weekend versus weekday. In‐hospital death doubled on the weekend compared with weekday (12% versus 6%) and was not attenuated by adjustment for potential confounders (odds ratio, 2.37; 95% CI, 1.93–2.91). There was no association between weekend discharge and 28‐day mortality among patients discharged alive. Conclusions The risk of in‐hospital death among patients admitted with ADHF appears to be doubled on the weekends when hospital staffing is usually reduced. However, among patients discharged alive, hospital discharge on a weekend is not adversely associated with mortality. See Editorial Mehta and Pandey
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Affiliation(s)
| | | | - Carla A Sueta
- University of North Carolina School of Medicine Chapel Hill NC
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