Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine

Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.

Download Full-text

Reply to the letter to the editor: “Clinical impact of red blood cell transfusion on adverse clinical events in acute heart failure patients with anemia”

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.03.001 ◽

2021 ◽

Author(s):

Satoshi Higuchi ◽

Shigeki Shibata ◽

Hiroshi Hasegawa ◽

Takeaki Matsuda

Keyword(s):

Heart Failure ◽

Blood Cell ◽

Acute Heart Failure ◽

Red Blood Cell ◽

Clinical Impact ◽

Red Blood Cell Transfusion ◽

Heart Failure Patients ◽

Clinical Events ◽

Letter To The Editor

Download Full-text

Acute Heart Failure in an Internal Medicine Department: A Prospective Study

Electronic Journal of General Medicine ◽

10.29333/ejgm/8573 ◽

2020 ◽

Vol 18 (1) ◽

pp. em263

Author(s):

Rita Reis Correia ◽

Pedro Leite Vieira ◽

Marisa Linhares ◽

Fábia Cruz ◽

Sandra Martin ◽

...

Keyword(s):

Internal Medicine ◽

Heart Failure ◽

Prospective Study ◽

Acute Heart Failure ◽

Medicine Department ◽

Internal Medicine Department ◽

A Prospective Study

Download Full-text

The impact of cultural and linguistic diversity on hospital readmission in patients hospitalized with acute heart failure

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcz034 ◽

2019 ◽

Vol 6 (2) ◽

pp. 121-129

Author(s):

Michael Seman ◽

Bill Karanatsios ◽

Koen Simons ◽

Roman Falls ◽

Neville Tan ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Hospital Readmission ◽

Limited English Proficiency ◽

Linguistic Diversity ◽

Linguistically Diverse ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Hospital Administrative ◽

The Impact

Abstract Aims Health services worldwide face the challenge of providing care for increasingly culturally and linguistically diverse (CALD) populations. The aims of this study were to determine whether CALD patients hospitalized with acute heart failure (HF) are at increased risk of rehospitalization and emergency department (ED) visitation after discharge, compared to non-CALD patients, and within CALD patients to ascertain the impact of limited English proficiency (LEP) on outcomes. Methods and results A cohort of 1613 patients discharged from hospital following an episode of acute HF was derived from hospital administrative datasets. CALD status was based on both country of birth and primary spoken language. Comorbidities, HF subtype, age, sex and socioeconomic status, and hospital readmission and ED visitation incidences, were compared between groups. A Cox proportional hazard model was employed to adjust for potential confounders. The majority of patients were classified as CALD [1030 (64%)]. Of these, 488 (30%) were designated as English proficient (CALD-EP) and 542 (34%) were designated CALD-LEP. Compared to non-CALD, CALD-LEP patients exhibited a greater cumulative incidence of HF-related readmission and ED visitation, as expressed by an adjusted hazard ratio (HR) [1.27 (1.02–1.57) and 1.40 (1.18–1.67), respectively]; this difference was not significant for all-cause readmission [adjusted HR 1.03 (0.88–1.20)]. CALD-EP showed a non-significant trend towards increased rehospitalization and ED visitation. Conclusion This study suggests that CALD patients with HF, in particular those designated as CALD-LEP, have an increased risk of HF rehospitalization and ED visitation. Further research to elucidate the underlying reasons for this disparity are warranted.

Download Full-text