Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Medicine, Weill Cornell Medicine, New York, New York.
Am J Cardiol. 2020 May 15;125(10):1529-1535. doi: 10.1016/j.amjcard.2020.02.018. Epub 2020 Mar 5.
Although several risk calculators are available to determine risk for readmission following a heart failure (HF) hospitalization, none provide information on cause-specific readmission. Understanding risk for cause-specific readmission could aid in developing a targeted approach to reducing readmissions. We sought to determine if a simple cardiac co-morbidity count could identify individuals at high risk for a cardiovascular (CV) readmission following a HF hospitalization. Using the Nationwide Readmissions Database, we examined nonfatal hospital discharges with a principal diagnosis of HF. We calculated a 0 to 3 cardiac co-morbidity count based on the presence of coronary artery disease, atrial arrhythmia, and/or ventricular arrhythmia. We used a multinomial logistic regression to determine if the cardiac co-morbidity count was independently associated with CV readmission or non-CV readmission, adjusting for patient- and hospital-level confounders. In 380,075 discharges, 28% had a co-morbidity count of 0, 47% had a count of 1, 23% had a count of 2, and 2% had a count of 3. In a fully adjusted model, cardiac co-morbidity count was independently associated with CV readmission: compared with individuals with a count of 0, the relative risk for those with a count of 1 was 1.27 (95% confidence interval [CI]: 1.23 to 1.31); for those with a count of 2 was 1.40 (95% CI: 1.35 to 1.46); and for those with a count of 3 was 1.36 (95% CI: 1.23 to 1.51). Cardiac co-morbidity count was not independently associated with non-CV readmission. In conclusion, we found that a simple cardiac co-morbidity count was independently associated with increased risk of CV but not non-CV readmission.
虽然有几种风险计算器可用于确定心力衰竭 (HF) 住院后的再入院风险，但没有一种提供与特定原因再入院相关的信息。了解特定原因再入院的风险有助于制定针对减少再入院的目标方法。我们试图确定简单的心脏合并症计数是否可以识别 HF 住院后发生心血管 (CV) 再入院的高危个体。我们使用全国再入院数据库，检查了以 HF 为主要诊断的非致命性医院出院情况。我们根据是否存在冠状动脉疾病、心房心律失常和/或室性心律失常，计算了 0 到 3 分的心脏合并症计数。我们使用多项逻辑回归来确定心脏合并症计数是否与 CV 再入院或非 CV 再入院独立相关，同时调整了患者和医院水平的混杂因素。在 380,075 次出院中，28%的患者合并症计数为 0，47%的患者计数为 1，23%的患者计数为 2，2%的患者计数为 3。在完全调整的模型中，心脏合并症计数与 CV 再入院独立相关：与计数为 0 的个体相比，计数为 1 的个体的相对风险为 1.27（95%置信区间 [CI]：1.23 至 1.31）；计数为 2 的个体的相对风险为 1.40（95% CI：1.35 至 1.46）；计数为 3 的个体的相对风险为 1.36（95% CI：1.23 至 1.51）。心脏合并症计数与非 CV 再入院无关。总之，我们发现简单的心脏合并症计数与 CV 但非非 CV 再入院的风险增加独立相关。
