Readmission following both cardiac and non‐cardiac acute dyspnoea is associated with a striking risk of death

Abstract Introduction Acute dyspnoea is a major reason for admission to the emergency department and has been associated with high rates of readmission and mortality. However, the association of readmission with mortality risk has not been widely studied in patients with acute dyspnoea. Purpose To determine whether unplanned readmission during first 6 months after discharge is associated with greater risk of death within 1 year in patients with acute dyspnoea. Methods Derivation cohort consisted of 1371 patients from the prospective observational study, which enrolled acute dyspnoea patients admitted to emergency departments of two university centres from 2015 to 2017 and discharged alive from the hospital. Cox regression analysis compared 1-year risk of death between readmitted vs. non-readmitted patients in the first 6 months after discharge. In addition, we studied this association in 1986 patients from a multicentre validation cohort, which included acute dyspnoea patients from 2006 to 2014. Sensitivity analysis was done in the subgroups divided by cause of index admission (acute heart failure [AHF] and non-AHF) and cause of the first readmission (cardiovascular [CV] or non-CV). The statistical analyses were performed using R statistical software. P value of <0.05 was considered statistically significant. Results In the derivation cohort 666 (49%) of patients were readmitted at 6 months and 282 (21%) died in 1 year. Readmitted patients died more frequently than non-readmitted patients (211 [32%] vs. 71 [10%], respectively, p<0.001). All-cause 6-month readmission was associated with an increased 1-year risk of death in a multivariate analysis in both the derivation cohort (adjusted hazard ratio (aHR) 3 [95% confidence interval (CI) 2.2–4], p<0.001) and the validation cohort (aHR 1.8 [95% CI 1.4–2.2], p<0.001). Moreover, deleterious effect of readmission on 1-year survival was equally observed in AHF and non-AHF patients, independent of whether the reason of first readmission was cardiovascular or non-CV, in both study cohorts. The results are displayed in Figure 1. Figure 1. Main results of the study Conclusions Our data demonstrates that readmission is associated with a markedly increased risk of death within 1 year in patients presenting to the emergency department with acute dyspnoea. Furthermore, the detrimental relationship between outcomes is similar in non-cardiac and cardiac causes. Acknowledgement/Funding The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.

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Pretreatment PSA Velocity and Risk of Death From Prostate Cancer Following External Beam Radiation Therapy

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/s1077-9108(08)70364-5 ◽

2007 ◽

Vol 2007 ◽

pp. 179-180

Author(s):

R. Dhir

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

External Beam Radiation Therapy ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation ◽

Risk Of Death ◽

Psa Velocity

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Allergy Shots at Home Don't Raise Risk of Death

Internal Medicine News ◽

10.1016/s1097-8690(06)73322-4 ◽

2006 ◽

Vol 39 (8) ◽

pp. 18

Author(s):

MICHELE G. SULLIVAN

Keyword(s):

Risk Of Death ◽

At Home

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“Music First”

GeroPsych ◽

10.1024/1662-9647/a000180 ◽

2018 ◽

Vol 31 (1) ◽

pp. 17-30 ◽

Cited By ~ 2

Author(s):

Dane L. Shiltz ◽

Tara T. Lineweaver ◽

Tim Brimmer ◽

Alex C. Cairns ◽

Danielle S. Halcomb ◽

...

Keyword(s):

Usual Care ◽

Psychological Symptoms ◽

Care Facility ◽

Care Group ◽

Music Listening ◽

Term Care ◽

Antipsychotic Medications ◽

Risk Of Death ◽

Extended Care ◽

Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

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Understanding Terminal Decline in Cognition and Risk of Death

European Psychologist ◽

10.1027/1016-9040.11.3.164 ◽

2006 ◽

Vol 11 (3) ◽

pp. 164-171 ◽

Cited By ~ 16

Author(s):

Patrick Rabbitt ◽

Mary Lunn ◽

Danny Wong

Keyword(s):

Risk Factors ◽

Longitudinal Study ◽

Test Scores ◽

Intelligence Test ◽

Practice Effects ◽

Risk Of Death ◽

Risk Of Mortality ◽

Impending Death ◽

Intelligence Test Scores ◽

Reduced Risk

There is new empirical evidence that the effects of impending death on cognition have been miscalculated because of neglect of the incidence of dropout and of practice gains during longitudinal studies. When these are taken into consideration, amounts and rates of cognitive declines preceding death and dropout are seen to be almost identical, and participants aged 49 to 93 years who neither dropout nor die show little or no decline during a 20-year longitudinal study. Practice effects are theoretically informative. Positive gains are greater for young and more intelligent participants and at all levels of intelligence and durations of practice; declines in scores of 10% or more between successive quadrennial test sessions are risk factors for mortality. Higher baseline intelligence test scores are also associated with reduced risk of mortality, even when demographics and socioeconomic advantage have been taken into consideration.

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