Weber Courtney, Hung Joseph, Hickling Siobhan, Li Ian, Murray Kevin, Briffa Tom
School of Population and Global Health, University of Western Australia, Crawley, Australia.
Medical School, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, Australia.
Heart Rhythm O2. 2022 Jun 16;3(5):511-519. doi: 10.1016/j.hroo.2022.06.002. eCollection 2022 Oct.
The healthcare burden of atrial fibrillation (AF) is dominated by hospitalizations, but data on 30-day unplanned readmissions after AF hospitalization and impact on mortality are limited.
To assess causes and trends of 30-day unplanned readmission in incident (first-ever) hospitalized AF patients, and the risk of readmission for subsequent all-cause mortality.
Patients aged 25-94 years, with an incident AF hospitalization (principal diagnosis) between 2001 and 2015, and surviving 30 days post discharge, were identified from linked Western Australian hospitalization and mortality data. Unplanned 30-day readmissions were categorized by principal diagnosis. Multivariable logistic and Cox regression analyses determined the independent predictors of readmission and the hazard ratio (HR) with 95% confidence intervals (CI) of readmission for subsequent 1-year mortality.
Of 22,814 patients, 57.7% male, mean age 67.8 ± 13.8 (standard deviation) years, 9.5% experienced 1 or more 30-day unplanned readmissions, with standardized rates increasing 2.0% annually (95% CI, 1.0%-3.1%). Among all readmissions, 64.8% were cardiovascular-related, with AF (31.7%), coronary events (12.2%), and heart failure (8.5%) being the most frequent. In 30-day survivors, 4.3% died within 1 year. Patients with any cardiovascular or noncardiovascular readmission (vs none) had a multivariable-adjusted mortality HR of 2.12 (95% CI, 1.82-2.45). Coexistent comorbidities were independently associated with 30-day unplanned readmission and 1-year mortality.
Following incident AF hospitalization, 30-day unplanned readmissions were common, mostly cardiovascular-related, but any readmission, regardless of cause, was associated with a 2-fold higher adjusted mortality risk. Our findings also support the importance of comorbidity optimization within an integrated care pathway to reduce adverse outcomes in AF patients.
心房颤动（AF）的医疗负担以住院治疗为主，但关于AF住院后30天内非计划再入院情况及其对死亡率影响的数据有限。
评估首次住院的AF患者30天内非计划再入院的原因和趋势，以及再入院导致后续全因死亡的风险。
从西澳大利亚州住院与死亡率关联数据中识别出年龄在25至94岁之间、在2001年至2015年间有首次AF住院（主要诊断）且出院后存活30天的患者。非计划30天再入院按主要诊断分类。多变量逻辑回归和Cox回归分析确定再入院的独立预测因素以及再入院对后续1年死亡率的风险比（HR）和95%置信区间（CI）。
在22814例患者中，男性占57.7%，平均年龄67.8±13.8（标准差）岁，9.5%经历了1次或更多次30天非计划再入院，标准化率每年增加2.0%（95%CI，1.0%-3.1%）。在所有再入院病例中，64.8%与心血管相关，其中AF（31.7%）、冠状动脉事件（12.2%）和心力衰竭（8.5%）最为常见。在30天存活者中，4.3%在1年内死亡。有任何心血管或非心血管再入院的患者（与无再入院患者相比）多变量调整后的死亡HR为2.12（95%CI，1.82-2.45）。共存的合并症与30天非计划再入院和1年死亡率独立相关。
首次AF住院后，30天非计划再入院很常见，大多与心血管相关，但任何原因的再入院，无论其原因如何，都与调整后死亡率风险高出2倍相关。我们的研究结果还支持在综合护理路径中优化合并症管理以降低AF患者不良结局的重要性。
