Special articleUnplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics?
Section snippets
Setting and patients
This study was conducted in the general internal medicine wards of the Hôpital Cantonal, the main teaching hospital of the University Hospitals of Geneva, Switzerland. This 1,200-bed urban public hospital is the major primary care hospital for the area. All patients who were discharged alive with a principal diagnosis of heart failure between 1993 and 1998 were eligible. Patients were identified using the following International Classification of Diseases–Clinical Modification (ICD9-CM) codes:
Results
We included 91 cases and 351 controls in the study. Among unplanned readmissions, 60 were considered as related to heart failure or to its treatment (41 relapses of heart failure and 19 other events to heart failure treatment, including digitalis toxicity, bradycardia, and drug-induced hypotension) and 31 were not.
Cases and controls differed significantly in terms of age, history of heart failure, revascularization status, mean comorbidity index, and cardiac rhythm at admission (Table 1). These
Discussion
Our study showed that among patients with heart failure, only suboptimal preparation for discharge, as measured by explicit criteria, was linked with early unplanned readmission, whereas criteria assessing the quality of the admission work-up and the evaluation and treatment during the stay were not. In contrast, patient characteristics, such as older age, a previous diagnosis of heart failure, and a history of cardiac revascularization had stronger effects on unplanned readmissions. These
Acknowledgements
We are indebted for their help and support to P. Dayer, MD, Medical Director, and F. Waldvogel, MD, Chairman of the Department of Internal Medicine, Geneva University Hospitals.
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