Abstract 242: Incidence, Predictors, Causes, and Costs for 30-day Readmission After In-Hospital Cardiopulmonary Resuscitation Discharge in United States

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Yusuke Morita ◽  
Tetsuya Haruna ◽  
Yoshisumi Haruna ◽  
Eisaku Nakane ◽  
Yuhei Yamaji ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiopulmonary Resuscitation ◽  
International Classification Of Diseases ◽  
Care Utilization ◽  
Hospital Discharges ◽  
Episode Of Care ◽  
Common Causes ◽  
Classification Of Diseases ◽  
Risk Patients ◽  
National Estimates

Background: Readmissions after in-hospital cardiopulmonary resuscitation (ICPR) are common and contribute to increased health care utilization and costs. This is the first study to estimate the burden and patterns of 30-day readmission after ICPR from Nationwide Readmission Database (NRD). Methods and Results: Patients undergoing ICPR (International Classification of Diseases-Ninth Revision-Clinical Modification codes 99.60 and 99.63) between January and November 2014 from NRD were included. Incidence, predictors, causes, and costs of 30-day readmission were analyzed using discharge weights to obtain national estimates. Among estimated 27278 index admissions survived to hospital discharges after ICPR, 5439 (20.0%) were readmitted within 30 days. Length of stay (LOS) ≧15 days during index hospitalization (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.16-1.42), Medicare or Medicaid insurance (HR, 1.34; 95% CI, 1.19-1.51), heart failure (HR, 1.2; 95% CI, 1.1-1.32), and discharge of metropolitan teaching hospital (HR, 1.19; 95% CI, 1.07-1.33) were independent predictors of 30-day readmission. Among 5439 readmissions, Sepsis (13.7%), heart failure (10.8%), respiratory failure (6.4%), and cardiac dysrhythmias (5.2%) were the most common causes. Estimated total costs of readmission were $102 million and mean of $19122 ±30201, which is accounted for 25.7% of total episode of care (index+readmission). The mean LOS was 8.0 ±10.5 days. The patients with readmission revealed high mortality rate of 10.1%. Conclusions: Thirty-day readmissions after ICPR are frequent and are related to baseline comorbidities and hospital characteristics. Awareness of these predictors can help identify and target high-risk patients for interventions, to reduce readmissions and costs.

scholarly journals Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319129
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Johan Grunewald ◽  
Anders Eklund ◽  
Daniela Di Giuseppe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
General Population ◽  
Strong Predictor ◽  
Strong Association ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Clinical Predictors ◽  
Cox Models ◽  
Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis

2021 ◽  
Author(s):  
Hua Wang ◽  
Ke Chai ◽  
Minghui Du ◽  
Shengfeng Wang ◽  
Jian-Ping Cai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Large Scale ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Unique Identifier ◽  
Classification Of Diseases ◽  
Per Capita ◽  
Mean Cost ◽  
Incident Cases

Background: Large-scale and population-based studies of heart failure (HF) incidence and prevalence are scarce in China. The study sought to estimate the prevalence, incidence, and cost of HF in China. Methods: We conducted a population-based study using records of 50.0 million individuals ≥25 years old from the national urban employee basic medical insurance from 6 provinces in China in 2017. Incident cases were individuals with a diagnosis of HF (International Classification of Diseases code, and text of diagnosis) in 2017 with a 4-year disease-free period (2013–2016). We calculated standardized rates by applying age standardization to the 2010 Chinese census population. Results: The age-standardized prevalence and incidence were 1.10% (1.10% among men and women) and 275 per 100 000 person-years (287 among men and 261 among women), respectively, accounting for 12.1 million patients with HF and 3.0 million patients with incident HF ≥25 years old. Both prevalence and incidence increased with increasing age (0.57%, 3.86%, and 7.55% for prevalence and 158, 892, and 1655 per 100 000 person-years for incidence among persons who were 25–64, 65–79, and ≥80 years of age, respectively). The inpatient mean cost per-capita was $4406.8 and the proportion with ≥3 hospitalizations among those hospitalized was 40.5%. The outpatient mean cost per-capita was $892.3. Conclusions: HF has placed a considerable burden on health systems in China, and strategies aimed at the prevention and treatment of HF are needed. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: ChiCTR2000029094.

scholarly journals Socioeconomic Burden of Rising Methamphetamine-Associated Heart Failure Hospitalizations in California From 2008 to 2018

2021 ◽  
Author(s):  
Susan X. Zhao ◽  
Andres Deluna ◽  
Kate Kelsey ◽  
Clifford Wang ◽  
Aravind Swaminathan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Planning ◽  
Statistical Significance ◽  
Negative Control Group ◽  
International Classification Of Diseases ◽  
Negative Control ◽  
Control Group ◽  
Public Health Response ◽  
Classification Of Diseases ◽  
Age Adjusted Rates

BACKGROUND: Methamphetamine-associated cardiomyopathy/heart failure (MethHF) is an increasingly recognized disease entity in the context of a rising methamphetamine (meth) epidemic that most severely impacts the western United States. Using heart failure (HF) hospitalization data from the Office of Statewide Health Planning and Development, this study aimed to assess trend and disease burden of MethHF in California. METHODS: Adult patients (≥18 years old) with HF as primary hospitalization diagnosis between 2008 and 2018 were included in this study. The association with Meth (MethHF) and those without (non-MethHF) were determined by meth-related International Classification of Diseases -based secondary diagnoses. Statistical significance of trends in age-adjusted rates of hospitalization per 100 000 adults were evaluated using nonparametric analysis. RESULTS: Between 2008 and 2018, 1 033 076 HF hospitalizations were identified: 42 565 were MethHF (4.12%) and 990 511 (95.88%) were non-MethHF. Age-adjusted MethHF hospitalizations per 100 000 increased by 585% from 4.1 in 2008 to 28.1 in 2018, while non-MethHF hospitalizations decreased by 6.0% from 342.3 in 2008 to 321.6 in 2018. The rate of MethHF hospitalization increase more than doubled that of a negative control group with urinary tract infection and meth-related secondary diagnoses (7.82-fold versus 3.48-fold, P <0.001). Annual inflation–adjusted hospitalization charges because of MethHF increased by 840% from $41.5 million in 2008 to $390.2 million in 2018, as compared with an 82% increase for all HF hospitalization from $3.503 billion to $6.376 billion. Patients with MethHF were significantly younger (49.64±10.06 versus 72.20±14.97 years old, P <0.001), predominantly male (79.1% versus 52.4%, P <0.001), with lower Charlson Comorbidity Index, yet they had longer length of stay, more hospitalizations per patient, and more procedures performed during their stays. CONCLUSIONS: MethHF hospitalizations increased sharply during the study period and contributed significantly to the HF hospitalization burden in California. This emerging HF phenotype, which engenders considerable financial and societal costs, calls for an urgent and concerted public health response to contain its spread.

Abstract 15678: In Patients Treated With Immune Checkpoint Inhibitors, Myocarditis is Infrequent Compared With Other Cardiovascular Events

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Judith A Hsia ◽  
Jessica Thurston ◽  
Lavanya Kondapalli ◽  
Ronni Miller ◽  
Rita Dale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Coronary Revascularization ◽  
International Classification Of Diseases ◽  
Alaskan Native ◽  
University Of Colorado ◽  
Before And After ◽  
Classification Of Diseases ◽  
The University

Introduction: Cardiotoxicity with immune checkpoint inhibitor (ICI) treatment has predominantly focused on myocarditis, which has been estimated to affect ~1% of treated patients. To contextualize myocarditis risk in relation to other cardiovascular (CV) events, we explored reporting of myocarditis, heart failure, arterial and venous thrombotic events in ICI-treated cancer patients. Methods: Data from adults treated with ICI between January 2011 and April 2019 were extracted by the University of Colorado enterprise health data warehouse which draws from electronic medical records and claims data. Medical conditions were determined by International Classification of Diseases (ICD) code; analyses was descriptive. Results: Among 1813 ICI-treated patients, mean age (SD) was 62.5 (13.5 years), 41% were women, 90% were white, 6% Hispanic, 2% black, 1% Asian, <1% American Indian/Alaskan native or native Hawaiian/Pacific islander and 1% multiple race. Prior to ICI initiation, 48% had hypertension, 16% diabetes, 11% were current smokers, 46% former smokers, 11% had estimated glomerular filtration rate <60 ml/min/1.73m 2 and 17% reported prior coronary revascularization. The most commonly treated malignancies were melanoma (40%) and lung cancer (31%). 47% of patients received pembrolizumab and 42% received nivolumab, the most often administered ICIs during this time period. Both before and after ICI administration, venous thromboembolism (VTE) and heart failure were the most frequently reported CV events (Figure). After initiation of ICI, myocardial infarction (MI) and stroke were reported for 54 (3.0%) and 73 (4.0%) patients, respectively. Myocarditis was more common after ICI than before ICI initiation (1 vs 9 patients [0.1%vs 0.5%]) but was infrequent compared with other CV events. Conclusions: Arterial and venous thrombotic events and heart failure were much more common than myocarditis in patients treated with ICI.

Abstract 3596: National Estimates of Down Syndrome Prevalence in Patients with Moyamoya Disease

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Daraspreet S Kainth ◽  
Saqib A Chaudhry ◽  
Hunar Kainth ◽  
M. Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Down Syndrome ◽  
Moyamoya Disease ◽  
Average Length ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
International Classification Of Diseases ◽  
Nursing Facilities ◽  
Patient Identification ◽  
Classification Of Diseases ◽  
National Estimates

Background: An association between Moyamoya disease and Down syndrome appears to exist based on reported anectdotal cases in the literature. Objective: We performed this study to determine the prevalence of Down syndrome associated with Moyamoya disease in inpatients and to identify the clinical features of Moyamoya disease that may be unique when associated with Down syndrome. Methods: We analyzed data from patients entered in the Nationwide Inpatient Sample between 2002 and 2009, using International Classification of Diseases codes for Moyamoya disease and Down syndrome for patient identification. Data including patient age, gender, ethnicity, secondary diagnosis, medical complications, hospital costs, and patient outcomes was obtained. Results: From 2002 to 2009, an estimated 518 patients (mean age [±SD] 16.2 [± 1.68] years) with co-existing Moyamoya disease and Down syndrome were admitted as inpatients. The estimated prevalence was 3.76% (3760 per 100,000) among patients admitted with Moyamoya disease and 10.6% (10,600 per 100,000) among patients aged under 15 years. Patients admitted with Moyamoya disease and Down syndrome were most frequently Caucasian and Hispanic (p=0.015). They were more likely to present with symptoms of ischemic stroke and less commonly with hemorrhagic stroke, 15.3% and 2.7%(p < 0.05), respectively. The average length of hospital stay was 8.7 days (3.0 - 14.4). The majority were discharged home, 6.9% to nursing facilities, and 1.8% died in the hospital. Conclusion: This is the first study to estimate the prevalence of Down syndrome in patients with Moyamoya disease. The 300 fold greater prevalence of Down syndrome in patients with Moyamoya disease compared with prevalence among live births (12 per 100,000) highlight the need for better understanding of common pathophysiology of both conditions .

Effect of β-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine Use

2018 ◽  
Vol 23 (6) ◽  
pp. 518-523 ◽  
Author(s):  
Obiora Egbuche ◽  
Ifunanya Ekechukwu ◽  
Valery Effoe ◽  
Nnamdi Maduabum ◽  
Heather R. Millard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
International Classification Of Diseases ◽  
Readmission Rates ◽  
Blocker Therapy ◽  
Cocaine Use ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Classification Of Diseases ◽  
Β Blocker

Background: β-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous β-blocker therapy (BBT) in patients who actively use cocaine remain controversial, and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in patients having HFrEF with concurrent cocaine use. Methods: We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure–related readmissions. Results: The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions. Conclusion: The BBT reduced 30-day, all-cause and heart failure–related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.

Abstract 15301: Skilled Nursing Facilities and 30-day Hospital Readmissions in Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
Jennifer St. Sauver ◽  
Susan A Weston ◽  
Ruoxiang Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
International Classification Of Diseases ◽  
Revolving Door ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Classification Of Diseases ◽  
The Impact

Background: Referral to a skilled nursing facility (SNF) should contribute to reducing hospital readmissions; however, a “revolving door” phenomenon after admission to SNF has been hypothesized to drive readmissions. The urgent need to study the impact of SNF on readmissions in heart failure (HF) was recently emphasized, yet this has never been studied in the community. Objectives: To evaluate the association between discharge to SNF and 30-day readmissions in a community cohort of hospitalized incident HF patients. Methods: Olmsted County, MN residents hospitalized with first ever (incident) HF (International Classification of Diseases-9 th Revision code 428) from 1995 through 2010 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Logistic regression was used to examine the association between discharge to SNF and 30-day readmissions. Results: Among 1360 HF patients (mean age 74±14, 47% male), 241(18%) were referred to a SNF. Overall, 296 (22%) patients were readmitted within 30-days after index hospitalization. The proportion of 30-day readmissions was greater among patients discharged to a SNF compared to patients discharged home (27% vs 21%, p=0.031). After adjustment for age and sex, patients discharged to a SNF had a 40% increase in the odds of having a hospital readmission within 30 days post HF compared to those discharged home (OR: 1.42, 95% CI 1.01-1.99). Further adjustment for year of HF diagnosis, ejection fraction, anemia, renal function, dementia and cancer did not alter the strength of the association (OR: 1.43, 95% CI: 0.99-2.09). Conclusion: Among community patients with HF, 30-day readmissions remain frequent and are more likely to occur among patients discharged to a SNF compared to those discharged home. These data provide new insight into the drivers of HF readmissions and suggest that interventions targeted to HF patients in SNFs may be warranted.

scholarly journals Processing of Electronic Medical Records for Health Services Research in an Academic Medical Center: Methods and Validation (Preprint)

2018 ◽  
Author(s):  
Nabilah Rahman ◽  
Debby D Wang ◽  
Sheryl Hui-Xian Ng ◽  
Sravan Ramachandran ◽  
Srinath Sridharan ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services Research ◽  
Health Services ◽  
International Classification Of Diseases ◽  
Care Utilization ◽  
Housing Type ◽  
Services Research ◽  
Diagnosis Codes ◽  
Classification Of Diseases

BACKGROUND Electronic medical records (EMRs) contain a wealth of information that can support data-driven decision making in health care policy design and service planning. Although research using EMRs has become increasingly prevalent, challenges such as coding inconsistency, data validity, and lack of suitable measures in important domains still hinder the progress. OBJECTIVE The objective of this study was to design a structured way to process records in administrative EMR systems for health services research and assess validity in selected areas. METHODS On the basis of a local hospital EMR system in Singapore, we developed a structured framework for EMR data processing, including standardization and phenotyping of diagnosis codes, construction of cohort with multilevel views, and generation of variables and proxy measures to supplement primary data. Disease complexity was estimated by Charlson Comorbidity Index (CCI) and Polypharmacy Score (PPS), whereas socioeconomic status (SES) was estimated by housing type. Validity of modified diagnosis codes and derived measures were investigated. RESULTS Visit-level (N=7,778,761) and patient-level records (n=549,109) were generated. The International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes were standardized to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) with a mapping rate of 87.1%. In all, 97.4% of the ICD-9-CM codes were phenotyped successfully using Clinical Classification Software by Agency for Healthcare Research and Quality. Diagnosis codes that underwent modification (truncation or zero addition) in standardization and phenotyping procedures had the modification validated by physicians, with validity rates of more than 90%. Disease complexity measures (CCI and PPS) and SES were found to be valid and robust after a correlation analysis and a multivariate regression analysis. CCI and PPS were correlated with each other and positively correlated with health care utilization measures. Larger housing type was associated with lower government subsidies received, suggesting association with higher SES. Profile of constructed cohorts showed differences in disease prevalence, disease complexity, and health care utilization in those aged above 65 years and those aged 65 years or younger. CONCLUSIONS The framework proposed in this study would be useful for other researchers working with EMR data for health services research. Further analyses would be needed to better understand differences observed in the cohorts.

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