Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure.

Little is known on predictors of hospitalisation in ambulatory patients with chronic heart failure, and known predictors may not apply to Mediterranean countries. Our aim was to document longitudinal trends in hospitalisations and identify patient-related predictors of hospital admission, re-admission and length of stay in the targeted population. Population-based retrospective cohort study in Catalonia (North-East Spain), including 7196 ambulatory patients (58.6% women; mean age 76 years). Eligible patients were selected from the electronic patient records of primary care practices, and followed for 3 years. At 3 years of follow up overall 645 (9.0%) patients had cardiovascular hospitalisation, 37% were readmitted, and median length of stay was 9 (interquartile range 5-17) days. Chronic kidney disease [odds ratio (OR)=1.98 (1.62-2.43)], IHD [OR=1.72 (1.45-2.04)], DM [OR=1.50 (1.27-1.78)] and chronic obstructive pulmonary disease [OR=1.43 (1.16-1.77)] increased the risk for hospitalisation. DM [OR=1.70 (1.22-2.38)], IHD [OR=1.85 (1.33-2.58)] and HTA [OR=1.66 (1.11-2.46)] increased the risk for readmissions. Chronic kidney disease [OR of 2.21 (1.70-2.90)], IHD [OR of 2.19 (1.73-2.77)], DM [OR=1.70 (1.34-2.15)], HTA [OR=1.51 (1.13-2.01)], chronic obstructive pulmonary disease [OR=1.37 (1.02-1.83)] increased the risk for long length of stay in hospital. Our study identified predictors of hospitalisation, readmissions and long length of stay which can help clinicians and managers to identify high risk patients which should be targeted on service planning and when designing preventive actions.

Frigola-Capell E ，Comin-Colet J ，Davins-Miralles J ，Gich-Saladich I ，Wensing M ，Verdú-Rotellar JM ... -  《-》

Something is amiss in Denmark: a comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente.

Schiøtz M ，Price M ，Frølich A ，Søgaard J ，Kristensen JK ，Krasnik A ，Ross MN ，Diderichsen F ，Hsu J ... -  《BMC HEALTH SERVICES RESEARCH》

Trends in Readmissions and Length of Stay for Patients Hospitalized With Heart Failure in Canada and the United States.

Samsky MD ，Ambrosy AP ，Youngson E ，Liang L ，Kaul P ，Hernandez AF ，Peterson ED ，McAlister FA ... -  《-》

Factors determining post-operative readmissions after left ventricular assist device implantation.

In the current era of extensive healthcare reform, there has been a heightened focus on the frequency and cause for readmissions within 30 days of discharge given that readmissions are not reimbursed by most providers. The aim of our study was to determine the frequency, etiology and patterns of 30-day readmissions among recipients of continuous-flow left ventricular assist devices (LVADs) at our institution as well to determine whether there were any significant predictors of readmission. From March 2006 through June 2013, 150 patients underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on their 30-day readmission status. A total of 12 patients died before discharge and were excluded from our analysis. Causes for 30-day readmissions and duration of hospital stay for the readmissions were recorded. Numerous pre-operative variables and post-operative complications were compared using 2-sided t-tests and chi-square tests between patients who were and were not readmitted within 30 days of their discharge after their LVAD implant. The 30-day readmission rate was 26.1% (36 of 138), with approximately 70% of post-operative readmissions occurring within 10 days of the patient's initial hospital discharge. Recurrent heart failure (12 of 36, 33.3%) and gastrointestinal bleeding (8 of 36, 22.2%) were the most common causes for 30-day readmission. The median length of stay (LOS) for readmission was 11.7 days. Thirty-day readmission did not affect short- or long-term survival. On univariate analysis, post-operative gastrointestinal bleeding (GIB) was a significant risk factor for 30-day readmissions (HR 1.4, 95% CI 0.19 to 0.99, p = 0.05), and overall length of stay was a significant factor in reducing 30-day readmission rates (HR 0.91, 95% CI 0.85 to 0.99, p = 0.02). Our experience indicates that 30-day readmission rates after LVAD implantation remain relatively high, with most occurring within 10 days of discharge. Recurrent heart failure and GIB were the most common causes of post-operative rehospitalization. In addition, GIB during the index hospitalization was a significant predictor of 30-day readmission.

Tsiouris A ，Paone G ，Nemeh HW ，Brewer RJ ，Morgan JA ... -  《-》

Prior hospital admission predicts thirty-day hospital readmission for heart failure patients.

McLaren DP ，Jones R ，Plotnik R ，Zareba W ，McIntosh S ，Alexis J ，Chen L ，Block R ，Lowenstein CJ ，Kutyifa V ... -  《-》