Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, and race did not differ by readmission status. After adjustment for patient and index admission characteristics, longer length of stay (≥ 4 vs < 4 days, OR = 1.48, 95% confidence interval [CI] 1.35 – 1.62), peripheral arterial disease (OR = 1.31, 95% CI 1.16 – 1.57), congestive heart failure (OR = 1.25, 95% CI 1.13 – 1.39), and ischemic heart disease (OR = 1.12, 95% CI 1.01 – 1.24) were associated with higher likelihood of readmission; index admission due to peritonitis vs other causes was associated with lower likelihood of readmission (OR = 0.80, 95% CI 0.70 – 0.92). Conclusions Our results suggest that, particularly in the absence of a PD-related cause of hospitalization such as peritonitis, PD patients may be at high risk for readmission and may benefit from closer post-discharge monitoring.

Download Full-text

Association between physical health and cardiovascular diseases: Effect modification by chronic conditions

SAGE Open Medicine ◽

10.1177/2050312118785335 ◽

2018 ◽

Vol 6 ◽

pp. 205031211878533

Author(s):

Nazmus Saquib ◽

Robert Brunner ◽

Manisha Desai ◽

Matthew Allison ◽

Lorena Garcia ◽

...

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Congestive Heart Failure ◽

Heart Disease ◽

Peripheral Arterial Disease ◽

Physical Component Summary ◽

Chronic Conditions ◽

Arterial Disease ◽

Physical Component Summary Score ◽

Peripheral Arterial

Objectives: This study assessed whether the physical component summary score of the RAND-36 health-related quality-of-life survey was associated with incidence of coronary heart disease, stroke, congestive heart failure, angina, or peripheral arterial disease, and whether baseline chronic conditions modified these associations. Methods: Analysis was limited to 69,155 postmenopausal women (50–79 years) in the Women’s Health Initiative Study who had complete data on the RAND-36, the outcomes, and covariates. Chronic conditions were defined as blood pressure ⩾140/90 mm or self-reported heart disease, diabetes, hypertension, arthritis, asthma, emphysema, cancer, and/or cholesterol-reducing medication use. Outcomes data were ascertained during follow-up (1993–2005) with medical records. Results: There were 2451 coronary heart disease, 1896 stroke, 1533 congestive heart failure, 1957 angina, and 502 peripheral arterial disease events during follow-up (median 8.2 years). Participants in the lowest physical component summary quintile, compared to the highest, had a significantly higher risk of developing coronary heart disease (hazard ratio (95% confidence interval) 2.0 (1.7, 2.3)), stroke (1.8 (1.5, 2.2)), angina (2.4(2.0, 2.9)), and peripheral arterial disease (3.0 (2.0, 4.4)), irrespective of chronic conditions. Interactions between physical component summary and existing chronic conditions were not significant for any outcome except congestive heart failure (p = 0.005); after adjustment, participants in the lowest physical component summary quintile and with any chronic condition had nearly a twofold higher risk of congestive heart failure (Yes = 4.4 (3.3, 5.8) vs No = 2.4 (1.2, 4.3)). Conclusion: We found a low physical component summary score was a significant risk factor for individual cardiovascular disease incidence in postmenopausal women.

Download Full-text

The Impact of Peripheral Arterial Disease on Patients with Congestive Heart Failure

Heart Failure Clinics ◽

10.1016/j.hfc.2013.10.006 ◽

2014 ◽

Vol 10 (2) ◽

pp. 327-338 ◽

Cited By ~ 4

Author(s):

Amit N. Keswani ◽

Christopher J. White

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Peripheral Arterial ◽

The Impact

Download Full-text

Physical activity and peripheral arterial disease among patients with coronary artery disease or congestive heart failure

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.01.149 ◽

2016 ◽

Vol 207 ◽

pp. 110-111 ◽

Cited By ~ 1

Author(s):

Paul D. Loprinzi

Keyword(s):

Physical Activity ◽

Heart Failure ◽

Coronary Artery Disease ◽

Congestive Heart Failure ◽

Coronary Artery ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Artery Disease ◽

Peripheral Arterial

Download Full-text

SS2. Congestive Heart Failure with Systolic Dysfunction Is Associated with Decreased Patency after Endovascular Intervention for Symptomatic Peripheral Arterial Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.03.037 ◽

2011 ◽

Vol 53 (6) ◽

pp. 16S

Author(s):

Andrew J. Meltzer ◽

Kathy A. Gallagher ◽

Sikandar Z. Khan ◽

Peter Connolly ◽

Francesco A. Aiello ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Peripheral Arterial Disease ◽

Systolic Dysfunction ◽

Arterial Disease ◽

Endovascular Intervention ◽

Peripheral Arterial

Download Full-text

Impact of Peripheral Arterial Disease on Functional Limitation in Congestive Heart Failure: Results from the National Health and Nutrition Examination Survey (1999–2004)

Cardiology Research and Practice ◽

10.1155/2012/306852 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Bamidele A. Adesunloye ◽

Ravinder Valadri ◽

Nkechi M. Mbaezue ◽

Anekwe E. Onwuanyi

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Peripheral Arterial Disease ◽

Functional Limitation ◽

Arterial Disease ◽

Nutrition Examination Survey ◽

Health And Nutrition ◽

Independent Association ◽

Peripheral Arterial ◽

Weighted Prevalence

Background. Peripheral arterial disease (PAD) often coexists with congestive heart failure (CHF) and can be masked by symptoms of CHF such as functional limitation (FL), a common manifestation for both. Therefore, we sought to estimate the prevalence of PAD and its independent association with FL in CHF.Methods.We conducted a cross-sectional study on National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 to quantify weighted prevalence of CHF and PAD. Study cohort consisted of 7513, with ankle brachial index (ABI) measurements at baseline. Independent association of PAD (ABI ≤ 0.9) with FL in CHF was determined with multivariate logistic regression (MVLR).Results.Overall weighted PAD prevalence was 5.2%. CHF was present in 305 participants, and the weighted prevalence of PAD in this subgroup was 19.2%. When compared, participants with CHF and PAD were more likely to be older (P<0.001), hypertensive (P=0.005) and hypercholesterolemic (P=0.013) than participants with CHF alone. MVLR showed that PAD (adjusted OR = 5.15; 95% CI: 2.2, 12.05:P<0.05) and arthritis (adjusted OR = 2.36; 95% CI: 1.10, 5.06: P<0.05) were independently associated with FL in CHF.Conclusion.Independent association of PAD with FL suggests the need for reinforced screening for PAD in individuals with CHF.

Download Full-text

HOSPITAL Score, LACE Index and LACE+ Index as predictors of 30-day readmission in patients with heart failure

BMJ evidence-based medicine ◽

10.1136/bmjebm-2019-111271 ◽

2019 ◽

Vol 25 (5) ◽

pp. 166-167 ◽

Cited By ~ 3

Author(s):

Abdisamad M Ibrahim ◽

Cameron Koester ◽

Mohammad Al-Akchar ◽

Nitin Tandan ◽

Manjari Regmi ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Patient Population ◽

Prediction Models ◽

Hospital Admissions ◽

Diastolic Heart Failure ◽

Hospital Readmissions ◽

Medical Patients ◽

Readmission Rates ◽

C Statistic

This study aimed to evaluate the accuracy of the HOSPITAL Score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalization, Index admission, number of hospital admissions, Length of stay) LACE index (Length of stay, Acute/emergent admission, Charlson comorbidy index score, Emerency department visits in previous 6 months) and LACE+ index in predicting 30-day readmission in patients with diastolic dysfunction. Heart failure remains one of the most common hospital readmissions in adults, leading to significant morbidity and mortality. Different models have been used to predict 30-day hospital readmissions. All adult medical patients discharged from the SIU School of Medicine Hospitalist service from 12 June 2016 to 12 June 2018 with an International Classification of Disease, 10th Revision, Clinical Modification diagnosis of diastolic heart failure were studied retrospectively to evaluate the performance of the HOSPITAL Score, LACE index and LACE+ index readmission risk prediction tools in this patient population. Of the 730 patient discharges with a diagnosis of heart failure with preserved ejection fraction (HFpEF), 692 discharges met the inclusion criteria. Of these discharges, 189 (27%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation showed C-statistic values to be 0.595 (95% CI 0.549 to 0.641) for the HOSPITAL Score, 0.551 (95% CI 0.503 to 0.598) for the LACE index and 0.568 (95% CI 0.522 to 0.615) for the LACE+ index, indicating poor specificity in predicting 30-day readmission. The result of this study demonstrates that the HOSPITAL Score, LACE index and LACE+ index are not effective predictors of 30-day readmission for patients with HFpEF. Further analysis and development of new prediction models are needed to better estimate the 30-day readmission rates in this patient population.

Download Full-text

Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00043 ◽

2018 ◽

Vol 38 (5) ◽

pp. 366-373 ◽

Cited By ~ 3

Author(s):

Satu Mäkelä ◽

Markku Asola ◽

Henrik Hadimeri ◽

James Heaf ◽

Maija Heiro ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Peripheral Arterial Disease ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Aortic Calcification ◽

Dialysis Patients ◽

X Ray ◽

Abdominal Aortic ◽

All Cause Mortality ◽

Peripheral Arterial

BackgroundPeripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.MethodsWe enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.ResultsThe median AACS was 11 (range 0 – 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low (< 0.9) in 17%, and high (> 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS ≥ 7 ( p < 0.001). The adjusted hazard ratio for all-cause mortality was 4.85 (95% confidence interval [CI] 1.94 – 24.46) for aortic calcification (AACS ≥ 7), 2.14 for diabetes (yes/no), 0.93 for albumin (per 1 g/L), and 1.04 for age (per year). A low or high ABI were not independently associated with mortality.ConclusionsSevere aortic calcification was a strong predictor of all-cause mortality in PD patients. The evaluation of aortic calcifications by lateral X ray is a simple method that allows the identification of high-risk patients.

Download Full-text