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

作　　者：Ahmed Maraey Mahmoud Salem Nabila Dawoud Mahmoud Khalil Ahmed Elzanaty Hadeer Elsharnoby Ahmed Younes Ahmed Hashim Amit Alam 

机构地区：[1]Department of Internal Medicine,the CHI St.Alexius Health,Bismarck,USA [2]Department of Internal Medicine,University of North Dakota,Bismarck,USA [3]Center for Advanced Heart and Lung Diseases,Baylor University Medical Center,Dallas,USA [4]Department of Internal Medicine,University of Kentucky,Lexington,USA [5]Department of Internal Medicine,Lincoln Medical Center Weil Cornell University,Bronx,USA [6]Department of Cardiovascular Medicine,Tanta University,Tanta,Egypt [7]Department of Cardiovascular Disease,University of Toledo,Toledo,USA [8]Faculty of Medicine,Tanta University,Tanta,Egypt [9]Department of Internal Medicine,East Carolina University,Greenville,USA [10]Faculty of Medicine,Ain Shams University,Cairo,Egypt [11]College of Medicine,Texas A&M Health Science Center,Dallas,USA

出　　处：《Journal of Geriatric Cardiology》2021年第12期1008-1018,共11页老年心脏病学杂志（英文版）

摘　　要：BACKGROUD Acute heart failure with preserved ejection fraction(HFpEF)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 HFpEF.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.Vari-ables 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(aOR)=1.20,95%CI:1.07−1.34,P=0.002]and diabetes mellitus(aOR=1.18,95%CI:1.07−1.29,P=0.001).Meanwhile,female(aOR=0.90,95%CI:0.82−0.99,P=0.028)and palliative care encounter(aOR=0.27,95%CI:0.21−0.34,P<0.001)were associated with lower odds of readmission.Cardiac arrhythmia(aOR=1.46,95%CI:1.11−1.93,P=0.007)and aortic stenosis(aOR=1.36,95%CI:1.05−1.76,P=0.020)were amongst predictors of in-hospital mortality.CONCLUSIONS In nonagenarians hospitalized with acute HFpEF,thirty-day readmission is common and costly.Chronic co-morbidities predict poor outcomes.Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.

关 键 词：fraction NATIONWIDE DOLLAR 

分 类 号：R541.6[医药卫生—心血管疾病]