Predictors of thirty-day readmission in nonagenarians presenting with acute heart failure with preserved ejection fraction: a nationwide analysis

被引:2
作者
Ahmed Maraey [1 ,2 ]
Mahmoud Salem [3 ]
Nabila Dawoud [4 ]
Mahmoud Khalil [5 ,6 ]
Ahmed Elzanaty [7 ]
Hadeer Elsharnoby [8 ]
Ahmed Younes [9 ]
Ahmed Hashim [10 ]
Amit Alam [3 ,11 ]
机构
[1] Faculty of Medicine, Ain Shams University
[2] College of Medicine, Texas A&M Health Science Center
[3] Department of Internal Medicine, the CHI St. Alexius Health
[4] Department of Internal Medicine,University of North Dakota
[5] Center for Advanced Heart and Lung Diseases, Baylor University Medical Center
[6] Department of Internal Medicine, University of Kentucky
[7] Department of Internal Medicine, Lincoln Medical Center Weil Cornell University
[8] Department of Cardiovascular Medicine, Tanta University
[9] Department of Cardiovascular Disease, University of Toledo
[10] Faculty of Medicine,Tanta University
[11] Department of Internal Medicine, East Carolina University
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中图分类号
R541.6 [血液循环衰竭];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUD Acute heart failure with preserved ejection fraction(HFp EF) is a common but poorly studied cause of hospital admissions among nonagenarians. This study aimed to evaluate predictors of thirty-day readmission, in-hospital mortality, length of stay, and hospital charges in nonagenarians hospitalized with acute HFp EF.METHODS Patients hospitalized between January 2016 and December 2018 with a primary diagnosis of diastolic heart failure were identified using ICD-10 within the Nationwide Readmission Database. We excluded patients who died in index admission,and discharged in December each year to allow thirty-day follow-up. Univariate regression was performed on each variable. Variables with P-value < 0.2 were included in the multivariate regression model.RESULTS From a total of 45,393 index admissions, 43,646 patients(96.2%) survived to discharge. A total of 7,437 patients(15.6%) had a thirty-day readmission. Mean cost of readmission was 43,265 United States dollars(USD) per patient. Significant predictors of thirty-day readmission were chronic kidney disease stage Ⅲ or higher [adjusted odds ratio(a OR) = 1.20, 95% CI:1.07-1.34, P = 0.002] and diabetes mellitus(a OR = 1.18, 95% CI: 1.07-1.29, P = 0.001). Meanwhile, female(a OR = 0.90, 95% CI:0.82-0.99, P = 0.028) and palliative care encounter(a OR = 0.27, 95% CI: 0.21-0.34, P < 0.001) were associated with lower odds of readmission. Cardiac arrhythmia(a OR = 1.46, 95% CI: 1.11-1.93, P = 0.007) and aortic stenosis(a OR = 1.36, 95% CI: 1.05-1.76, P =0.020) were amongst predictors of in-hospital mortality.CONCLUSIONS In nonagenarians hospitalized with acute HFp EF, thirty-day readmission is common and costly. Chronic comorbidities predict poor outcomes. Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.
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页码:1008 / 1018
页数:11
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