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Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure

Citation

Huynh, Q and Negishi, K and De Pasquale, C and Hare, J and Leung, D and Stanton, T and Marwick, TH, Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure, Medical Journal of Australia, 208, (11) pp. 485-491. ISSN 0025-729X (2018) [Refereed Article]

Copyright Statement

Copyright 2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.

DOI: doi:10.5694/mja17.00809

Abstract

Objectives: To investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes.

Design: Cohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF.

Main Outcome Measures: All-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission.

Results: 58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings.

Conclusions: Differences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.

Item Details

Item Type:Refereed Article
Keywords:continuity of patient care, delivery of health care, heart failure, managed care programs
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Huynh, Q (Dr Quan Huynh)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
ID Code:126355
Year Published:2018
Web of Science® Times Cited:6
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-06-06
Last Modified:2019-03-07
Downloads:0

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