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Sindet-Pedersen C, El-Chouli M, Nouhravesh N, Lamberts M, Christensen DM, Kümler T, Lock M, Grove EL, Holt A, Schou M, Gislason G, Butt JH, Strange JE. High risk of rehospitalization within 1 year following a pulmonary embolism-insights from the Danish nationwide registries from 2000-2020. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:256-264. [PMID: 37541959 DOI: 10.1093/ehjqcco/qcad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/06/2023]
Abstract
AIM To identify the absolute risk, causes, and factors associated with rehospitalization within 1 year of discharge with a pulmonary embolism (PE). METHODS AND RESULTS Using the Danish nationwide registries, all patients admitted with a first-time PE between 2000 and 2020 and discharged alive were included. Subsequent hospitalizations were categorized and crude cumulative incidences were used to estimate the absolute risk (AR) of any rehospitalization and specific causes of rehospitalizations. Risk factors for rehospitalization were investigated using cause specific Cox regression models.A total of 55 201 patients were identified. The median age of the study population was 70 years (inter quartile range: 59;79), and the most prevalent comorbidities were cancer (29.3%) and ischemic heart disease (12.7%). The 1-year AR of any rehospitalization after discharge with a PE was 48.6% (95% confidence interval (CI); 48.2%-48.8%). The most common cause for being rehospitalized was due to respiratory disease [1-year AR: 9.5% (95% CI: 9.3%-9.8%)], followed by cardiovascular disease [1-year AR: 6.3% (95% CI: 5.9%-6.5%)], cancer [1-year AR: 6.0% (95% CI: 5.8%-6.4%)], venous thromboembolism [1-year AR: 5.2% (95% CI: 5.0%-5.2%)], and symptom diagnoses [1-year AR: 5.2% (95% CI: 5.0%-5.4%)]. Factors that were associated with an increased risk of rehospitalization were cancer, liver disease, chronic obstructive pulmonary disease, chronic kidney disease, and immobilization. CONCLUSION Patients with PE have a high risk of rehospitalization, with almost half of patients being rehospitalized within 1 year. Identification of high-risk patients may help target interventions aiming at reducing the risk of rehospitalization.
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Affiliation(s)
- Caroline Sindet-Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Mohamad El-Chouli
- The Danish Heart Foundation, 1120 Copenhagen K, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Morten Lamberts
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | | | - Thomas Kümler
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Morten Lock
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark
| | - Anders Holt
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- The Danish Heart Foundation, 1120 Copenhagen K, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Jawad Haider Butt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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Park HM, Han T, Heo SJ, Kwon YJ. Effectiveness of the triglyceride-glucose index and triglyceride-glucose-related indices in predicting cardiovascular disease in middle-aged and older adults: A prospective cohort study. J Clin Lipidol 2024; 18:e70-e79. [PMID: 38044202 DOI: 10.1016/j.jacl.2023.11.006] [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: 08/24/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUNDS Cardiovascular disease (CVD) risk assessment is a crucial component of public health. We aimed to determine the predictive value of the triglyceride-glucose (TyG) index and TyG-related indices for new-onset CVD. METHODS This prospective study included 7,808 participants aged 40-69 years from the Ansung-Ansan cohort database. Our analysis was stratified by diabetes status. The hazard ratio (HR) with a 95% confidence interval (CI) for incident CVD was computed using multiple Cox proportional-hazards regression models. To evaluate the predictive performance of these indices for new-onset CVD, we calculated the Harrell's C-index (95% CI). RESULTS In this study, a total of 6,890 participants did not have diabetes at baseline, while 918 participants had diabetes. In participants without diabetes, compared to the lowest tertile, fully adjusted HR and 95% CI for new-onset CVD in the highest tertile were as follows: TyG (HR 1.42, 95% CI 1.06-1.90), TyG-body mass index (BMI) (HR 1.92, 95% CI 1.19-3.10), TyG-waist circumference (WC) (HR 2.37, 95% CI 1.61-3.49), and TyG-waist-to-height ratio (WHtR) (HR 2.20, 95% CI 1.47-3.28). However, no significant associations were observed between TyG, modified TyG indices, and new-onset CVD in participants with diabetes. Notably, the C-indice of TyG-WC and TyG-WHtR were significantly higher than those of TyG and TyG-BMI in participants without diabetes. CONCLUSIONS TyG-BMI, TyG-WC, and TyG-WHtR were associated with an increased risk of new-onset CVD in participants without diabetes. Furthermore, TyG-WC and TyG-WHtR showed better predictive performances for new-onset CVD than TyG and TyG-BMI in participants without diabetes.
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Affiliation(s)
- Hye-Min Park
- Standard Primary Care Center, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea (Hye-Min Park)
| | - Taehwa Han
- Health-IT Center, Yonsei University Severance Hospital, Seoul 03722, Republic of Korea (Taehwa Han)
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (Seok-Jae Heo)
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea (Yu-Jin Kwon).
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Maghsoudi S, Mazloom SR, Rafiei H, Mohammadmousaei F, Ghaderi MS, Mafi MH. The Effect of a Healthcare Services Hotline on Quality of Life and Hospital Readmissions for Patients with Chronic Obstructive Pulmonary Disease. Home Healthc Now 2023; 41:90-97. [PMID: 36867482 DOI: 10.1097/nhh.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common debilitating disease marked by frequent exacerbations and hospitalizations, economic burden, and reduced quality of life. This study aimed to determine the effect of a healthcare hotline on quality of life and hospital readmissions within 30 days of discharge for patients with COPD. Sixty patients with COPD who needed home healthcare services were recruited for this quasi-experimental study. A direct hotline was provided to patients and their caregivers in the intervention group to answer their questions about the disease. Data were collected using a demographics checklist, and St. George Respiratory Questionnaire. The number of hospitalizations and mean length of hospital stay in the intervention group within 30 days was significantly lower than the control group (p < 0.05). As for quality of life, only the mean score of symptoms was significantly different between the intervention and control groups (p < 0.05). The results showed the positive effect of a healthcare hotline on reducing readmission rates within 30 days of discharge and its low effect on quality of life of COPD patients.
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Rajaguru V, Kim TH, Han W, Shin J, Lee SG. LACE Index to Predict the High Risk of 30-Day Readmission in Patients With Acute Myocardial Infarction at a University Affiliated Hospital. Front Cardiovasc Med 2022; 9:925965. [PMID: 35898272 PMCID: PMC9309494 DOI: 10.3389/fcvm.2022.925965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background The LACE index (length of stay, acuity of admission, comorbidity index, and emergency room visit in the past 6 months) has been used to predict the risk of 30-day readmission after hospital discharge in both medical and surgical patients. This study aimed to utilize the LACE index to predict the risk of 30-day readmission in hospitalized patients with acute myocardial infraction (AMI). Methods This was a retrospective study. Data were extracted from the hospital's electronic medical records of patients admitted with AMI between 2015 and 2019. LACE index was built on admission patient demographic data, and clinical and laboratory findings during the index of admission. The multivariate logistic regression was performed to determine the association and the risk prediction ability of the LACE index, and 30-day readmission were analyzed by receiver operator characteristic curves with C-statistic. Results Of the 3,607 patients included in the study, 5.7% (205) were readmitted within 30 days of discharge from the hospital. The adjusted odds ratio based on logistic regression of all baseline variables showed a statistically significant association with the LACE score and revealed an increased risk of readmission within 30 days of hospital discharge. However, patients with high LACE scores (≥10) had a significantly higher rate of emergency revisits within 30 days from the index discharge than those with low LACE scores. Despite this, analysis of the receiver operating characteristic curve indicated that the LACE index had favorable discrimination ability C-statistic 0.78 (95%CI; 0.75–0.81). The Hosmer–Lemeshow goodness- of-fit test P value was p = 0.920, indicating that the model was well-calibrated to predict risk of the 30-day readmission. Conclusion The LACE index demonstrated the good discrimination power to predict the risk of 30-day readmissions for hospitalized patients with AMI. These results can help clinicians to predict the risk of 30-day readmission at the early stage of hospitalization and pay attention during the care of high-risk patients. Future work is to be focused on additional factors to predict the risk of 30-day readmissions; they should be considered to improve the model performance of the LACE index with other acute conditions by using administrative data.
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Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Whiejong Han
- Department of Global Health Security, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea
- *Correspondence: Sang Gyu Lee
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David F, Philipp J, Henrike AB, Nikolaos PP, Christine PH, Martin C, Oliver PR, Benjamin S. Impact of the Educational Level on Non-Fatal Health Outcomes following Myocardial Infarction. Curr Probl Cardiol 2022; 47:101340. [DOI: 10.1016/j.cpcardiol.2022.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
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Rajaguru V, Kim TH, Shin J, Lee SG, Han W. Ability of the LACE Index to Predict 30-Day Readmissions in Patients with Acute Myocardial Infarction. J Pers Med 2022; 12:jpm12071085. [PMID: 35887582 PMCID: PMC9318277 DOI: 10.3390/jpm12071085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: This study aimed to utilize the existing LACE index (length of stay, acuity of admission, comorbidity index and emergency room visit in the past six months) to predict the risk of 30-day readmission and to find the associated factors in patients with AMI. Methods: This was a retrospective study and LACE index scores were calculated for patients admitted with AMI between 2015 and 2019. Data were utilized from the hospital’s electronic medical record. Multivariate logistic regression was performed to find the association between covariates and 30-day readmission. The risk prediction ability of the LACE index for 30-day readmission was analyzed by receiver operating characteristic curves with the C statistic. Results: A total of 205 (5.7%) patients were readmitted within 30 days. The odds ratio of older age group (OR = 1.78, 95% CI: 1.54–2.05), admission via emergency ward (OR = 1.45; 95% CI: 1.42–1.54) and LACE score ≥10 (OR = 2.71; 95% CI: 1.03–4.37) were highly associated with 30-day readmissions and statistically significant. The receiver operating characteristic curve C statistic of the LACE index for AMI patients was 0.78 (95% CI: 0.75–0.80) and showed favorable discrimination in the prediction of 30-day readmission. Conclusion: The LACE index showed a good discrimination to predict the risk of 30-day readmission for hospitalized patients with AMI. Further study would be recommended to focus on additional factors that can be used to predict the risk of 30-day readmission; this should be considered to improve the model performance of the LACE index for other acute conditions by using the national-based administrative data.
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Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea; (V.R.); (T.H.K.)
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea; (V.R.); (T.H.K.)
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea; (J.S.); (S.G.L.)
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea; (J.S.); (S.G.L.)
| | - Whiejong Han
- Department of Global Health Security, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
- Correspondence:
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