Ahmad Shahzad, Ashraf Muddasir, Salehin Salman, Hasan Syed Mustajab, Sadia Haleema, Khalife Wissam, Chatila Khaled F
Department of Internal Medicine, Division of cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Department of Internal Medicine, Arora St Luke's Medical Center, Milwaukee, WI, USA.
Am J Med Sci. 2023 Nov;366(5):347-354. doi: 10.1016/j.amjms.2023.08.002. Epub 2023 Aug 8.
We analyzed trends, causes and predictors of 30-days readmission in cardiac amyloidosis and inspected the impact of these readmissions on mortality, morbidity, and utilization of healthcare resources.
Heart Failure with cardiac amyloidosis patients were selected from National readmission Database (NRD) using ICD-10 CM codes. Patients younger than 18 years, elective readmissions, readmissions due to trauma, patients with missing data and December 2018 admissions were excluded. Primary outcome was all-cause 30-day readmissions rate, secondary outcomes were factors associated with 30-days readmissions and their effect on morbidity, mortality, and healthcare resource utilization.
Out of 4123 total heart failure with cardiac amyloidosis index admissions in 2018, 3374 patients were included in final analysis. 19.6% were readmitted within 30 days. Readmitted patients were younger, sicker, admitted to small or large hospital. Hypertensive heart and Chronic Kidney Disease (CKD Stage I-IV) with Congestive Heart Failure (CHF), hypertensive heart and CKD (Stage V) or End Stage Renal Disease (ESRD) with CHF, hypertensive heart disease with CHF, acute kidney failure, and sepsis were the most common causes of readmissions. Young age, admission to small and large size hospitals were independent predictors of 30-day readmissions. Readmissions had higher mortality, costed 6.6 extra in hospital days to patients and $16380 per admission to healthcare system.
Cardiac amyloidosis readmissions were associated with increased morbidity and mortality of patients and extra burden on the healthcare system. There is a need to identify patients at risk for readmissions to improve patient outcomes and decrease healthcare cost.
我们分析了心脏淀粉样变性患者30天再入院的趋势、原因及预测因素，并考察了这些再入院情况对死亡率、发病率及医疗资源利用的影响。
使用国际疾病分类第十版临床修正版（ICD-10 CM）编码从国家再入院数据库（NRD）中选取心脏淀粉样变性伴心力衰竭患者。排除年龄小于18岁的患者、择期再入院患者、因创伤导致的再入院患者、有数据缺失的患者以及2018年12月入院的患者。主要结局为全因30天再入院率，次要结局为与30天再入院相关的因素及其对发病率、死亡率和医疗资源利用的影响。
在2018年4123例心脏淀粉样变性伴心力衰竭指数入院患者中，3374例患者纳入最终分析。19.6%的患者在30天内再次入院。再入院患者更年轻、病情更重，入住小型或大型医院。高血压性心脏病合并慢性肾脏病（CKD I-IV期）伴充血性心力衰竭（CHF）、高血压性心脏病合并CKD（V期）或终末期肾病（ESRD）伴CHF、高血压性心脏病伴CHF、急性肾衰竭和脓毒症是再入院的最常见原因。年轻、入住小型和大型医院是30天再入院的独立预测因素。再入院患者死亡率更高，每位患者住院天数增加6.6天，每次入院给医疗系统造成额外16380美元的费用。
心脏淀粉样变性再入院与患者发病率和死亡率增加以及医疗系统额外负担相关。有必要识别有再入院风险的患者，以改善患者预后并降低医疗成本。
