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Unplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics?

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Abstract

PURPOSE: To determine if early unplanned readmissions of patients hospitalized for heart failure are associated with suboptimal in-hospital care or with the clinical and demographic characteristics of the patient.

SUBJECT AND METHODS: We performed a case-control study among patients discharged with a principal diagnosis of heart failure. Cases included all patients unexpectedly readmitted within 31 days of discharge; controls were randomly selected from among those not readmitted. Quality of care was measured using explicit criteria reflecting the admission work-up, evaluation and treatment, and readiness for discharge.

RESULTS: Ninety-one cases and 351 controls were included. There was no significant association between early unplanned readmissions and the scores for quality of the admission work-up or evaluation and treatment during the stay. There was a significant association between readiness for discharge and subsequent early readmission: for each 10% decrease in the proportion of fulfilled criteria, the odds of readmission increased by 14% (95% confidence interval [CI] 1.01 to 1.28, P = 0.04) for all-cause readmissions and by 19% (95% CI: 1.04 to 1.36, P = 0.01) for heart-failure–related readmissions. In a multiple logistic regression model, previous diagnosis of heart failure (odds ratio [OR] = 2.9, 95% CI: 1.7 to 4.8, P <0.001), age (OR = 3.3, 95% CI: 1.3 to 8.5, P = 0.01 for patients aged 65 to 79 years and OR = 4.1, 95% CI: 1.6 to 11, P = 0.004 for patients aged 80 years and older), and history of cardiac revascularization (OR = 2.1, 95% CI: 1.2 to 3.9, P = 0.01) showed a stronger association with early unplanned all-cause readmissions than the readiness-for-discharge score (OR = 1.16, 95% CI: 1.02 to 1.31, P = 0.02). Similar findings were seen for heart failure-related readmissions.

CONCLUSIONS: Among patients with heart failure, early unplanned readmissions were not associated with suboptimal admission work-up or evaluation and treatment but were weakly associated with readiness for discharge. However, they were strongly associated with the patients’ clinical and demographic 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.

References (22)

  • J Gooding et al.

    Hospital readmissions among the elderly

    J Am Geriatr Soc

    (1985)
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