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Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure

journal contribution
posted on 2023-05-19, 18:39 authored by Huynh, Q, Kazuaki Negishi, De Pasquale, C, Hare, J, Leung, D, Stanton, T, Marwick, TH
Objectives: To investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes.

Design: Cohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF.

Main Outcome Measures: All-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission.

Results: 58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings.

Conclusions: Differences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.

History

Publication title

Medical Journal of Australia

Volume

208

Issue

11

Pagination

485-491

ISSN

0025-729X

Department/School

Menzies Institute for Medical Research

Publisher

Australasian Med Publ Co Ltd

Place of publication

Level 1, 76 Berry St, Sydney, Australia, Nsw, 2060

Rights statement

Copyright 2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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