Maraey Ahmed, Salem Mahmoud, Dawoud Nabila, Khalil Mahmoud, Elzanaty Ahmed, Elsharnoby Hadeer, Younes Ahmed, Hashim Ahmed, Alam Amit
Department of Internal Medicine, the CHI St. Alexius Health, Bismarck, USA.
Department of Internal Medicine, University of North Dakota, Bismarck, USA.
J Geriatr Cardiol. 2021 Dec 28;18(12):1008-1018. doi: 10.11909/j.issn.1671-5411.2021.12.005.
Acute heart failure with preserved ejection fraction (HFpEF) is a common but poorly studied cause of hospital admissions among nonagenarians. This study aimed to evaluate predictors of thirty-day readmission, in-hospital mortality, length of stay, and hospital charges in nonagenarians hospitalized with acute HFpEF.
Patients hospitalized between January 2016 and December 2018 with a primary diagnosis of diastolic heart failure were identified using ICD-10 within the Nationwide Readmission Database. We excluded patients who died in index admission, and discharged in December each year to allow thirty-day follow-up. Univariate regression was performed on each variable. Variables with -value < 0.2 were included in the multivariate regression model.
From a total of 45,393 index admissions, 43,646 patients (96.2%) survived to discharge. A total of 7,437 patients (15.6%) had a thirty-day readmission. Mean cost of readmission was 43,265 United States dollars (USD) per patient. Significant predictors of thirty-day readmission were chronic kidney disease stage III or higher [adjusted odds ratio (aOR) = 1.20, 95% CI: 1.07-1.34, = 0.002] and diabetes mellitus (aOR = 1.18, 95% CI: 1.07-1.29, = 0.001). Meanwhile, female (aOR = 0.90, 95% CI: 0.82-0.99, = 0.028) and palliative care encounter (aOR = 0.27, 95% CI: 0.21-0.34, < 0.001) were associated with lower odds of readmission. Cardiac arrhythmia (aOR = 1.46, 95% CI: 1.11-1.93, = 0.007) and aortic stenosis (aOR = 1.36, 95% CI: 1.05-1.76, = 0.020) were amongst predictors of in-hospital mortality.
In nonagenarians hospitalized with acute HFpEF, thirty-day readmission is common and costly. Chronic comorbidities predict poor outcomes. Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.
射血分数保留的急性心力衰竭（HFpEF）是导致九旬老人住院的常见病因，但相关研究较少。本研究旨在评估因急性HFpEF住院的九旬老人30天再入院、住院死亡率、住院时间和住院费用的预测因素。
利用全国再入院数据库中的ICD-10识别2016年1月至2018年12月期间因舒张性心力衰竭初次诊断而住院的患者。我们排除了在首次入院时死亡以及每年12月出院的患者，以便进行30天随访。对每个变量进行单因素回归分析。P值<0.2的变量纳入多因素回归模型。
在总共45393例首次入院患者中，43646例（96.2%）存活至出院。共有7437例患者（15.6%）在30天内再次入院。再次入院的平均费用为每位患者43265美元。30天再入院的显著预测因素为慢性肾脏病III期或更高分期[调整后比值比（aOR）=1.20，95%置信区间（CI）：1.07-1.34，P=0.002]和糖尿病（aOR=1.18，95%CI：1.07-1.29，P=0.001）。同时，女性（aOR=0.90，95%CI：0.82-0.99，P=0.028）和接受姑息治疗（aOR=0.27，95%CI：0.21-0.34，P<0.001）与再入院几率较低相关。心律失常（aOR=1.46，95%CI：1.11-1.93，P=0.007）和主动脉瓣狭窄（aOR=1.36，95%CI：1.05-1.76，P=0.020）是住院死亡率的预测因素。
在因急性HFpEF住院的九旬老人中，30天再入院很常见且费用高昂。慢性合并症预示预后不良。需要制定进一步的策略来提高护理质量并预防九旬老人的不良结局。
