Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK.
Department of Cardiology, Belgrade University Medical Centre, Belgrade, Serbia.
Am J Cardiol. 2019 Sep 1;124(5):736-745. doi: 10.1016/j.amjcard.2019.05.053. Epub 2019 Jun 6.
Hospital readmissions remain a continued challenge in the care of patients with heart failure (HF). This study aims to examine the rates, temporal trends, predictors and causes of 30-day unplanned readmissions after admission with HF. Patients hospitalized with a primary or secondary diagnosis of HF in the U.S. Nationwide Readmission Database were included. We examined the incidence, trends, predictors and causes of unplanned all-cause readmissions at 30-days. A total of 2,635,673 and 8,342,383 patients were included in the analyses for primary and secondary diagnoses of HF, respectively. The 30-day unplanned readmission rate was 15.1% for primary HF and 14.6% for secondary HF. Predictors of readmission in primary HF included renal failure (OR 1.27 (1.25 to 1.28)), cancer (OR 1.26 (1.22 to 1.29)), receipt of circulatory support (OR 2.81 (1.64 to 4.81)) and discharge against medical advice (OR 2.29 (2.20 to 2.39)). In secondary HF, the major predictors were receipt of circulatory support (OR 1.43 (1.12 to 1.84)) and discharge against medical advice (OR 2.01 95%CI (1.95 to 2.07)). In primary HF 52.4% of patients were readmitted for a noncardiac cause while for secondary HF 73.9% were readmitted for a noncardiac cause. For secondary HF, the strongest predictor of readmission was discharge against medical advice (OR 2.06 95%CI 2.01 to 2.12, p < 0.001). Early unplanned readmissions are common among patients hospitalized with HF, and a majority of readmissions are due to causes other than HF. Our results highlight the need to better manage comorbidities in patients with HF.
在心力衰竭（HF）患者的治疗中，医院再入院仍然是一个持续存在的挑战。本研究旨在探讨美国全国再入院数据库中因 HF 入院后 30 天内计划外再入院的发生率、时间趋势、预测因素和原因。我们检查了 30 天内非计划性全因再入院的发生率、趋势、预测因素和原因。共有 2635673 例和 8342383 例患者分别纳入主要和次要 HF 诊断的分析。原发性 HF 的 30 天未计划再入院率为 15.1%，继发性 HF 为 14.6%。原发性 HF 再入院的预测因素包括肾功能衰竭（OR 1.27（1.25 至 1.28））、癌症（OR 1.26（1.22 至 1.29））、接受循环支持（OR 2.81（1.64 至 4.81））和违反医嘱出院（OR 2.29（2.20 至 2.39））。在继发性 HF 中，主要预测因素是接受循环支持（OR 1.43（1.12 至 1.84））和违反医嘱出院（OR 2.01 95%CI（1.95 至 2.07））。在原发性 HF 中，52.4%的患者因非心脏原因再次入院，而在继发性 HF 中，73.9%的患者因非心脏原因再次入院。对于继发性 HF，再入院的最强预测因素是违反医嘱出院（OR 2.06 95%CI 2.01 至 2.12，p < 0.001）。HF 住院患者早期计划外再入院很常见，大多数再入院是由于 HF 以外的原因。我们的研究结果强调了需要更好地管理 HF 患者的合并症。
