scholarly journals Association between Severity of Anemia and 30-Day Readmission Rate: Archival Data of 847 Patients with Acute Decompensated Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Jorge C. Busse ◽  
Tanya M. Cohn ◽  
Rosalina Butao ◽  
Julie Lamoureux
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
High Rate ◽  
Archival Data ◽  
Readmission Rates ◽  
Low Sodium ◽  
Related Group ◽  
The Impact

Hospitals today are facing adjustments to reimbursements from excessive readmission rates. One of the most common and expensive causes of readmissions is exacerbation of a heart failure condition. The objective of this paper was to determine if there was an association between the presence of anemia in patients with acute decompensated heart failure and their readmission rate. Using archival data of 4 hospitals in the Miami area, a sample of 847 inpatients with a diagnostic related group (DRG) of HF at discharge was considered. There was a significant association between low hemoglobin values and a high rate of readmissions at 14 days and at 30 days in subjects with normal sodium and creatinine values. For subjects with low sodium and high creatinine values, a higher readmission rate was seen in men with low hemoglobin but not in women. These results support a prospective effort to measure the impact of anemia and its treatment on readmission rates.

scholarly journals The Impact of Discharged Loop Diuretic Dose to Home Dose on Hospital Readmissions in Patients with Acute Decompensated Heart Failure: A Retrospective Cohort Study

2020 ◽  
Vol 23 (4) ◽  
pp. E470-E474 ◽  
Author(s):  
Mohannad Alshibani ◽  
Samah Alshehri ◽  
Wejdan Alyazidi ◽  
Asmaa Alnomani ◽  
Ziyad Almatruk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Retrospective Cohort ◽  
Readmission Rate ◽  
Dose Group ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Readmission Rates ◽  
Daily Discharge

Background: Acute decompensated heart failure (ADHF) is associated with a high rate of hospital readmission. The aim of this study is to examine the effect of the discharge diuretic dose compared with the home diuretic dose on hospital readmission in patients with ADHF. Methods: A single center retrospective cohort study included patients with a confirmed diagnosis of ADHF with an ejection fraction of less than 40%. The sample was divided in two groups. The first group received a total daily discharge diuretic dose that was greater than the home dose; the second group received a daily discharge diuretic that was equal to or less than the home dose. The primary outcome was all-cause 30-day readmission rate. The secondary outcomes were all-cause 60-day and 90-day readmission rates. Results: A total of 206 patients met inclusion criteria; 117 patients received a higher loop diuretic dose at discharge, while 89 were discharged with a loop diuretic that was equal to or less than the home dose. Patients in the increased-dose group had an all-cause 30-day readmission rate of 20.5% compared with 37.1% of patients with equal or reduced-dose group; P = .007. Additionally, there were lower readmission rates in 60 and 90 days between the increased and equal or reduced groups (33.3% versus 52.8%, P < .017, and 41.0% versus 62.9%, P < .003, respectively. Conclusions: Among patients admitted to hospital with ADHF and reduced ejection fraction, a discharge loop diuretic dose higher than the home dose was associated with decreased all-cause 30-day, 60-day, and 90-day readmission rates.

scholarly journals The Impact of Early Tolvaptan Administration in the Patients Admitted by Acute Decompensated Heart Failure

2016 ◽  
Vol 22 (9) ◽  
pp. S187
Author(s):  
Kei Tsukamoto ◽  
Kenjiro Oyabu ◽  
Kazuyuki Hamada ◽  
Syun Hasegawa ◽  
Masahiro Watanabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
The Impact

Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis

2017 ◽  
Vol 22 (6) ◽  
pp. 685-698 ◽  
Author(s):  
Waqas Javed Siddiqui ◽  
Andrew R. Kohut ◽  
Syed F Hasni ◽  
Jesse M. Goldman ◽  
Benjamin Silverman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Readmission Rate ◽  
Acute Decompensated Heart Failure ◽  
Meta Analysis ◽  
Decompensated Heart Failure

scholarly journals ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2019 ◽  
pp. 61-63
Author(s):  
PRUDENCE A RODRIGUES ◽  
SOUMYA GK ◽  
NADIA GRACE BUNSHAW ◽  
SARANYA N ◽  
SUJITH K ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Injury ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Loop Diuretics ◽  
Contributing Factors ◽  
The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

scholarly journals Acute decompensated heart failure in a non cardiology tertiary referral centre, Sarawak General Hospital (SGH-HF)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hwei Sung Ling ◽  
Bui Khiong Chung ◽  
Pin Fen Chua ◽  
Kai Xin Gan ◽  
Wai Leng Ho ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Hospital ◽  
Readmission Rate ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Asia Pacific ◽  
Socioeconomic Background ◽  
Evidence Based ◽  
Short Term ◽  
Cardiopulmonary Support

Abstract Background Data on clinical characteristics of acute decompensated heart failure (ADHF) in Malaysia especially in East Malaysia is lacking. Methods This is a prospective observational study in Sarawak General Hospital, Medical Department, from October 2017 to September 2018. Patients with primary admission diagnosis of ADHF were recruited and followed up for 90 days. Data on patient’s characteristics, precipitating factors, medications and short-term clinical outcomes were recorded. Results Majority of the patients were classified in lower socioeconomic group and the mean age was 59 years old. Hypertension, diabetes mellitus and dyslipidaemia were the common underlying comorbidities. Heart failure with ischemic aetiology was the commonest ADHF admission precipitating factor. 48.6% of patients were having preserved ejection fraction HF and the median NT-ProBNP level was 4230 pg/mL. Prescription rate of the evidence-based heart failure medication was low. The in-patient mortality and the average length of hospital stay were 7.5% and 5 days respectively. 43% of patients required either ICU care or advanced cardiopulmonary support. The 30-day, 90-day mortality and readmission rate were 13.1%, 11.2%, 16.8% and 14% respectively. Conclusion Comparing with the HF data from West and Asia Pacific, the short-term mortality and readmission rate were high among the ADHF patients in our study cohort. Maladaptation to evidence-based HF prescription and the higher prevalence of cardiovascular risk factors in younger patients were among the possible issues to be addressed to improve the HF outcome in regions with similar socioeconomic background.

scholarly journals Renal Function during Hospitalization and Outcome in Chinese Patients with Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Hao-Wei Lee ◽  
Chin-Chou Huang ◽  
Chih-Yu Yang ◽  
Hsin-Bang Leu ◽  
Po-Hsun Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Clinical Outcomes ◽  
Acute Decompensated Heart Failure ◽  
Significant Risk ◽  
Decompensated Heart Failure ◽  
Chinese Patients ◽  
Cox Regression Analysis ◽  
The Impact

Abstract It is well known that the heart and kidney have a bi-directional correlation, in which organ dysfunction results in maladaptive changes in the other. We aimed to investigate the impact of renal function and its decline during hospitalization on clinical outcomes in patients with acute decompensated heart failure (ADHF). A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF), defined as eGFR decline between admission (eGFRadmission) and pre-discharge (eGFRpredischarge), occurred in 41 patients. Clinical outcomes during the follow-up period were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. During an average follow-up period of 2.6±3.2 years, 66 patients experienced 4P-MACE. Cox regression analysis revealed that impaired eGFRpredischarge, but not eGFRadmission or WRF, was significantly correlated with the development of 4P-MACE (HR, 2.003; 95% CI, 1.072–3.744; P=0.029). In conclusion, impaired renal function before discharge, but not WRF, is a significant risk factor for poor outcomes in patients with ADHF.

Abstract 118: Physician Specific Practice Patterns and 30-day Heart Failure Readmission Rates: Is One Way Better Than the Other?

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Anish B Bhatt ◽  
Daniel Cheeran ◽  
Sandeep Das
Keyword(s):  
Heart Failure ◽  
Resource Utilization ◽  
Readmission Rate ◽  
Beta Blockers ◽  
Management Strategies ◽  
Beta Blockade ◽  
Diagnostic Code ◽  
Readmission Rates ◽  
Physician Practices ◽  
The Impact

Background: Heart failure (HF) admissions place a significant burden on hospital resource utilization. Management of inpatient HF remains heterogeneous, from daily diuresis to discharge strategies. We sought to evaluate if specific physician practices were associated with two important contributors to resource utilization, readmission and length of stay (LOS). Methods: Physician-specific discharges, LOS, and 30-day readmission rates from 7/1/2015-6/30/2016 were extracted from the EHR. Patients with “shock” as the primary diagnostic code were excluded. We created a survey to assess HF management strategies that was administered to all cardiologists and hospitalists at our institution; physicians were blinded to LOS and readmission data. Many factors potentially impacting LOS and discharge decisions were queried, including physical examination, medication use and kidney function. Results: We received 62 of 69 (90%) survey responses – 26 cardiologists and 36 hospitalists. Overall, 52% (32 of 62) were male with a median 7 years in practice [IQR 3-13]. We tracked HF utilization metrics in 58 physicians, encompassing 753 patient discharges in the preceding year. Total 30-day readmission rate was 17.0% (128 of 753). No significant differences were seen in discharge practices between readmission rate tertiles. Median of the median LOS was 4.7 days (IQR 4.0-5.8), and physicians above median LOS were compared to physicians below median LOS. Point estimates suggest physicians with lower median LOS targeted a daily net diuresis goal greater than 3L (40% vs 11% for those above median LOS, p = 0.1), and were less likely to hold beta blockers (17% vs 37%, p = 0.1) or to consider 24 hours of inpatient oral diuretics prior to discharge to be “very important” (16% vs 56%, p < 0.01). The pooled readmission rate of physicians below median LOS was not significantly different than those above median LOS (14.5% vs 16.2%, p = 0.6). Conclusions: We identified three specific HF management patterns that may be associated with lower LOS without a concomitant increase in 30-day readmission: (1) more aggressive daily diuresis, (2) continuation of beta blockade, and (3) not delaying discharge to observe 24 hours of an oral diuretic regimen. Further studies are warranted to confirm and quantify the impact of these changes on resource utilization.

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