Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA.
Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
Eur J Heart Fail. 2018 Feb;20(2):304-314. doi: 10.1002/ejhf.1020. Epub 2017 Oct 29.
Patients hospitalized for heart failure (HF) are at high risk for 30-day readmission. This study sought to examine the timings and causes of readmission within 30 days of an HF hospitalization.
Timing and cause of readmission in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial were assessed. Early and late readmissions were defined as admissions occurring within 0-7 days and 8-30 days post-discharge, respectively. Patients who died in hospital or remained hospitalized at day 30 post-randomization were excluded. Patients were compared by timing and cause of readmission. Logistic and Cox proportional hazards regression analyses were used to identify independent risk factors for early vs. late readmission and associations with 180-day outcomes. Of the 6584 patients (92%) in the ASCEND-HF population included in this analysis, 751 patients (11%) were readmitted within 30 days for any cause. Overall, 54% of readmissions were for non-HF causes. The median time to rehospitalization was 11 days (interquartile range: 6-18 days) and 33% of rehospitalizations occurred by day 7. Rehospitalization within 30 days was independently associated with increased risk for 180-day all-cause death [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.93-2.94; P < 0.001]. Risk for 180-day all-cause death did not differ according to early vs. late readmission (HR 0.99, 95% CI 0.67-1.45; P = 0.94).
In this hospitalized HF trial population, a significant majority of 30-day readmissions were for non-HF causes and one-third of readmissions occurred in the first 7 days. Early and late readmissions within the 30-day timeframe were associated with similarly increased risk for death. Continued efforts to optimize multidisciplinary transitional care are warranted to improve rates of early readmission.
因心力衰竭（HF）住院的患者有在 30 天内再次入院的高风险。本研究旨在探讨 HF 住院后 30 天内再次入院的时间和原因。
评估 ASCEND-HF（急性心力衰竭临床疗效的奈西立肽研究）试验中再入院的时间和原因。早期和晚期再入院分别定义为出院后 0-7 天和 8-30 天内的入院。排除住院期间死亡或随机分组后第 30 天仍住院的患者。根据再入院的时间和原因对患者进行比较。采用逻辑回归和 Cox 比例风险回归分析确定早期与晚期再入院的独立危险因素，并分析与 180 天结局的关系。在纳入本分析的 ASCEND-HF 人群的 6584 例患者（92%）中，有 751 例（11%）因任何原因在 30 天内再次入院。总体而言，54%的再入院是由于非 HF 原因。再次住院的中位时间为 11 天（四分位距：6-18 天），33%的再入院发生在第 7 天。30 天内再次入院与 180 天全因死亡风险增加独立相关[风险比（HR）2.38，95%置信区间（CI）1.93-2.94；P<0.001]。早期与晚期再入院与 180 天全因死亡风险无差异（HR 0.99，95%CI 0.67-1.45；P=0.94）。
在本住院 HF 试验人群中，大多数 30 天再入院是由于非 HF 原因，三分之一的再入院发生在第 7 天内。30 天时间范围内的早期和晚期再入院与死亡风险增加相关。需要继续努力优化多学科过渡性护理，以提高早期再入院率。
