Diagnosis for readmission of senile patients hospitalized with acute decompensated heart failure in different departments: a retrospective cross-sectional study.

BACKGROUND

Short-term hospital readmissions for acute heart failure lead to the rise of health care budget and all-cause death. Elderly patients with acute or decompensated heart failure are often admitted to different wards (either the geriatric department or other departments). The diagnosis for readmission, cost and length of hospital stay in different wards are not well known.

METHODS

A retrospective study was conducted examining senile patients admitted to the hospital over a 1-year period. Data related to demographic information, comorbidities, ejection fraction (EF), brain natriuretic peptide (BNP) levels, costs, and discharge disposition were collected from electronic medical record.

RESULTS

A total of 3,922 cases were enrolled in this study. There were 1,316 patients with heart failure who were re-hospitalized, among which, 893 were admitted to the geriatric department. The top 3 diagnosis for re-hospitalization for more than 7 days in the geriatric department were pneumonia (38.5%), blood pressure fluctuations (19.4%), and acute coronary syndrome (ACS) (13.3%). The factors for readmission to other departments were pneumonia (32.5%), arrhythmia (17.7%), and blood pressure fluctuations (15.5%). The top 3 diagnosis for rehospitalizations lasting 7 days or less in the geriatric department were blood pressure fluctuations (26.5%), arrhythmia (23.4%), and fatigue or stress (16.9%), while ACS (24.1%), blood pressure fluctuations (22.5%), and arrhythmia (14.7%) were the top 3 diagnosis for other departments. The geriatric department tended to receive more senile patients, with lower BNP levels (625.13±823.71 929.31±873.38 pg/mL), and longer duration of hospitalization (24.38±5.228 15.65±5.907 days). However, there was no significant difference in the total cost of admission between geriatric department and other departments ($4,483 $4,415, P=0.129).

CONCLUSIONS

Our study identified a higher readmission rate in senile acute decompensated heart failure patients. Pneumonia was listed as the top 1 diagnosis for longer hospital stay in different department. Those rehospitalized with pneumonia may benefit from geriatric department.