Trochez Ricardo J, Barrett Jennifer B, Shi Yaping, Schildcrout Jonathan S, Rick Chelsea, Nair Devika, Welch Sarah A, Kumar Anupam A, Bell Susan P, Kripalani Sunil
Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Hosp Med. 2024 May;19(5):386-393. doi: 10.1002/jhm.13316. Epub 2024 Feb 24.
Hospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions.
We examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure.
DESIGNS, SETTINGS, AND PARTICIPANTS: This prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study.
The primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES-13).
Among 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR] = 1.36, 95% confidence interval [CI]: 1.06-1.75) in the first 90 days after discharge. The VES-13 score was not associated with readmission for cardiovascular causes (RRR = 0.94, 95% CI: 0.75-1.17).
Vulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES-13 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.
心力衰竭患者再次入院很常见。身体功能下降的易感性可能会增加这些患者非心血管原因再次入院的风险，但人们对易感性与非计划再次入院原因之间的关联了解甚少，这阻碍了有效干预措施的制定。
我们研究了急性失代偿性心力衰竭住院患者的易感性与再次入院原因（心血管原因与非心血管原因）之间的关联。
设计、地点和参与者：这项前瞻性纵向研究是范德比尔特住院患者队列研究的一部分。
主要结局是非计划再次入院的原因（心血管原因与非心血管原因）。主要自变量是易感性，使用脆弱老年人调查（VES-13）进行测量。
在804例急性失代偿性心力衰竭住院患者中，315例（39.2%）在出院后90天内经历了非计划再次入院。在以未再次入院为参照组的多项逻辑回归模型中，较高的易感性与出院后前90天内因非心血管原因再次入院相关（相对风险比[RRR]=1.36，95%置信区间[CI]：1.06-1.75）。VES-13评分与因心血管原因再次入院无关（RRR=0.94，95%CI：0.75-1.17）。
功能下降的易感性预测了心力衰竭住院患者的非心血管再次入院风险。VES-13是一种简短、经过验证且免费可用的工具，在规划护理过渡时应予以考虑。需要开展更多工作来检验干预措施的效果，以监测和缓解从医院出院的脆弱心力衰竭患者的非心血管问题。
