Readmissions after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study

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Background:
Patients aged ≥65 years are vulnerable to readmissions due to a transient period of generalized risk after hospitalization. However, whether young and middle-aged adults share a similar risk pattern is uncertain. We compared the rate, timing, and readmission diagnoses following hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among patients aged 18–64 years with patients aged ≥65 years.

Methods and Findings:
We used an all-payer administrative dataset from California consisting of all hospitalizations for HF (n = 206,141), AMI (n = 107,256), and pneumonia (n = 199,620) from 2007–2009. The primary outcomes were unplanned 30-day readmission rate, timing of readmission, and readmission diagnoses. Our findings show that the readmission rate among patients aged 18–64 years exceeded the readmission rate in patients aged ≥65 years in the HF cohort (23.4% vs. 22.0%, p<0.001), but was lower in the AMI (11.2% vs. 17.5%, p<0.001) and pneumonia (14.4% vs. 17.3%, p<0.001) cohorts. When adjusted for sex, race, comorbidities, and payer status, the 30-day readmission risk in patients aged 18–64 years was similar to patients ≥65 years in the HF (HR 0.99; 95%CI 0.97–1.02) and pneumonia (HR 0.97; 95%CI 0.94–1.01) cohorts and was marginally lower in the AMI cohort (HR 0.92; 95%CI 0.87–0.96). For all cohorts, the timing of readmission was similar; readmission risks were highest between days 2 and 5 and declined thereafter across all age groups. Diagnoses other than the index admission diagnosis accounted for a substantial proportion of readmissions among age groups <65 years; a non-cardiac diagnosis represented 39–44% of readmissions in the HF cohort and 37–45% of readmissions in the AMI cohort, while a non-pulmonary diagnosis represented 61–64% of patients in the pneumonia cohort.

Conclusion:
When adjusted for differences in patient characteristics, young and middle-aged adults have 30-day readmission rates that are similar to elderly patients for HF, AMI, and pneumonia. A generalized risk after hospitalization is present regardless of age.

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Vyšlo v časopise: Readmissions after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study. PLoS Med 11(9): e32767. doi:10.1371/journal.pmed.1001737
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001737

Souhrn

Zdroje

1. JencksSF, WilliamsMV, ColemanEA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360: 1418–1428.

2. KrumholzHM, LinZ, DryeEE, DesaiMM, HanLF, et al. (2011) An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 4: 243–252.

3. KeenanPS, NormandSL, LinZ, DryeEE, BhatKR, et al. (2008) An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes 1: 29–37.

4. LindenauerPK, NormandSL, DryeEE, LinZ, GoodrichK, et al. (2011) Development, validation, and results of a measure of 30-day readmission following hospitalization for pneumonia. J Hosp Med 6: 142–150.

5. HallMJ, LevantS, DeFrancesCJ (2012) Hospitalization for Congestive Heart Failure: United States, 2000–2010. National Center for Health Statistics Data Brief 108 Available: http://www.cdc.gov/nchs/data/databriefs/db108.htm. Accessed 1 November 2013.

6. NieminenMS, BrutsaertD, DicksteinK, DrexlerH, FollathF, et al. (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27: 2725–2736.

7. MandelzweigL, BattlerA, BoykoV, BuenoH, DanchinN, et al. (2006) The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J 27: 2285–2293.

8. American Lung Association (2010) Trends in Pneumonia and Influenza Morbidity and Mortality. American Lung Association Available: http://www.lung.org/finding-cures/our-research/trend-reports/pi-trend-report.pdf. Accessed 1 November 2013.

9. StrangesE, KowlessarN, ElixhauserA (2011) Component of Growth in Inhospital Hospital Costs, 1997–2009. HCUP Statistical Brief 123 Available: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb123.jsp. Accessed 1 July 2013.

10. Howden LM, Meyer JA (2011) Age and Sex Composition: 2010. 2010 Census Briefs: U.S. Census Bureau. Available: http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf. Accessed 1 July 2013.

11. DharmarajanK, HsiehAF, LinZ, BuenoH, RossJS, et al. (2013) Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA 309: 355–363.

12. KrumholzHM (2013) Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med 368: 100–102.

13. Jiang HJ, Weir LM (2010) All-Cause Hospital Readmissions among Non-Elderly Medicaid Patients, 2007. Healthcare Cost and Utilization Project Statistical Brief 89. Rockville (MD): Agency for Healthcare Research and Quality.

14. SommersACP (2011) Physician visits after hospital discharge: implications for reducing readmissions. National Institute for Health Care Reform

15. Centers for Medicare and Medicaid Services (2013) Readmissions Reduction Program. Available: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed 1 November 2013.

16. Centers for Medicare and Medicaid Services (2013) Community-based Care Transitions Program. Available: http://innovation.cms.gov/initiatives/CCTP/. Accessed 1 November 2013.

17. HansenLO, YoungRS, HinamiK, LeungA, WilliamsMV (2011) Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 155: 520–528.

18. ParkerSG, PeetSM, McPhersonA, CannabyAM, AbramsK, et al. (2002) A systematic review of discharge arrangements for older people. Health Technol Assess 6: 1–183.

19. Boutwell A HS (2009) Effective interventions to reduce rehospitalizations: a survey of the published evidence. Cambridge, MA: Institute for Healthcare Improvement.

20. Elixhauser A, Steiner C (2006) Readmissions to U.S. hospitals by diagnosis, 2010: Statistical Brief #153. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD).

21. Pope GC ER, Ash AS, Ayanian JZ, Bates DW, Burstin H, Iezzoni LI, Marcantonio E, Wu B (2000) Diagnostic Cost Group Hierarchical Condition Category Models for Medicare Risk Adjustment. Report Prepared for the Health Care Financing Administration. Waltham, MA: Health Economics Research, Inc.

22. Centers for Medicare & Medicaid Services (2013) Planned Readmission Algorithm. Available: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Measure-Methodology.html. Accessed 1 July 2013.

23. DunlaySM, WestonSA, KillianJM, BellMR, JaffeAS, et al. (2012) Thirty-day rehospitalizations after acute myocardial infarction: a cohort study. Ann Intern Med 157: 11–18.

24. JastiH, MortensenEM, ObroskyDS, KapoorWN, FineMJ (2008) Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis 46: 550–556.

25. O'ConnorCM, MillerAB, BlairJE, KonstamMA, WedgeP, et al. (2010) Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction: results from Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) program. Am Heart J 159: 841–849 e841.

26. BuiAL, HorwichTB, FonarowGC (2011) Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8: 30–41.

27. GrahamJE, RockwoodK, BeattieBL, EastwoodR, GauthierS, et al. (1997) Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 349: 1793–1796.

28. TomakaJ, ThompsonS, PalaciosR (2006) The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health 18: 359–384.

29. FultonMM, AllenER (2005) Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 17: 123–132.

30. MasoudiFA, BaillieCA, WangY, BradfordWD, SteinerJF, et al. (2005) The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998–2001. Arch Intern Med 165: 2069–2076.

31. McCuskerJ, KakumaR, AbrahamowiczM (2002) Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci 57: M569–577.

32. WitloxJ, EurelingsLS, de JongheJF, KalisvaartKJ, EikelenboomP, et al. (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304: 443–451.

33. PassarelliMC, Jacob-FilhoW, FiguerasA (2005) Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging 22: 767–777.

34. KrumholzHM, WangY, MatteraJA, WangYF, HanLF, et al. (2006) An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction. Circulation 113: 1683–1692.

35. LindenauerPK, BernheimSM, GradyJN, LinZ, WangY, et al. (2010) The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for Medicare beneficiaries with pneumonia. J Hosp Med 5: E12–18.

36. YanY, Birman-DeychE, RadfordMJ, NilasenaDS, GageBF (2005) Comorbidity indices to predict mortality from Medicare data: results from the national registry of atrial fibrillation. Med Care 43: 1073–1077.

37. KiyotaY, SchneeweissS, GlynnRJ, CannuscioCC, AvornJ, et al. (2004) Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. Am Heart J 148: 99–104.