PMID- 38271260
OWN - NLM
STAT- MEDLINE
DCOM- 20240328
LR  - 20240329
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 11
IP  - 2
DP  - 2024 Apr
TI  - Multifactorial risk factors for hospital readmissions among patients with 
      symptoms of advanced heart failure.
PG  - 1144-1152
LID - 10.1002/ehf2.14670 [doi]
AB  - AIMS: Economic burden of heart failure is attributed to hospital readmissions. 
      Previous studies assessing risk factors for readmissions have focused on single 
      group of risk factors, were limited to 30-day readmissions, or did not account 
      for competing risk of mortality. This study investigates the biological, 
      socio-economic, and behavioural risk factors predicting hospital readmissions 
      while accounting for the competing risk of mortality. METHODS AND RESULTS: In 
      this prospective cohort study, we recruited 250 patients hospitalized with 
      symptoms of advanced heart failure [New York Heart Association (NYHA) Class III 
      and IV] between July 2017 and April 2019. We analysed their baseline survey data 
      and their hospitalization records over the next 4.5 years (July 2017 to January 
      2022). We used a joint-frailty model to determine the multifactorial risk factors 
      for all-cause and unplanned hospital readmissions and mortality. At the time of 
      recruitment, patients' mean (SD) age was 66 (12) years, majority being male (72%) 
      and NYHA class IV (68%) with reduced ejection fraction (72%). 87% of the patients 
      had poor self-care behaviours, 51% had diabetes and 56% had weak grip strength. 
      Within 2 years of a hospital admission, 74% of the patients had at least one 
      readmission. Among all readmissions during follow-up, 68% were unplanned. Results 
      from the multivariable regression analysis shows that the independent risk 
      factors for hospital readmissions were biologic-weak grip strength [hazard ratio 
      (95% CI): 1.59 (1.06, 2.13)], poor functional status [1.79 (0.98, 2.61)], 
      diabetes [1.42 (0.97, 1.86)]; behavioural-poor self-care [1.66 (0.84, 2.49)], and 
      socio-economic-preference for maximal life extension at high cost for those with 
      high education [1.98 (1.17, 2.80)]. Risk factors for unplanned hospital 
      readmissions were similar. A higher hospital readmission rate increased the risk 
      of mortality [1.86 (1.23, 2.50)]. Other risk factors for mortality were 
      biologic-weak grip strength [3.65 (0.57, 6.73)], diabetes [2.52 (0.62, 4.42)], 
      socio-economic-lower education [2.45 (0.37, 4.53)], and being married [2.53 
      (0.37, 4.69)]. Having a private health insurance [0.40 (0.08, 0.73)] lowered the 
      risk for mortality. CONCLUSIONS: Risk factors for hospital readmissions and 
      mortality are multifactorial. Many of these factors, such as weak grip strength, 
      diabetes, poor self-care behaviours, are potentially modifiable and should be 
      routinely assessed and managed in cardiac clinics and hospital admissions.
CI  - (c) 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of European Society of Cardiology.
FAU - Malhotra, Chetna
AU  - Malhotra C
AD  - Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
AD  - Health Services and Systems Research, Duke-NUS Medical School, Singapore, 
      Singapore.
FAU - Chaudhry, Isha
AU  - Chaudhry I
AD  - Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
FAU - Keong, Yeo Khung
AU  - Keong YK
AD  - National Heart Centre Singapore, Singapore.
FAU - Sim, Kheng Leng David
AU  - Sim KLD
AD  - National Heart Centre Singapore, Singapore.
LA  - eng
GR  - NMRC/HSRG/0053/2016/Health Services Research Competitive Research Grant, Ministry 
      of Health, Singapore/
PT  - Journal Article
DEP - 20240125
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
RN  - 0 (Biological Products)
SB  - IM
MH  - Humans
MH  - Male
MH  - Aged
MH  - Female
MH  - Patient Readmission
MH  - Prospective Studies
MH  - *Heart Failure
MH  - Risk Factors
MH  - *Diabetes Mellitus
MH  - *Biological Products
PMC - PMC10966253
OTO - NOTNLM
OT  - Functional status
OT  - Heart failure
OT  - Hospital readmissions
OT  - Self-care
OT  - Weak grip strength
COIS- The authors do not have any conflicts of interest to declare.
EDAT- 2024/01/25 18:42
MHDA- 2024/03/28 06:45
PMCR- 2024/01/25
CRDT- 2024/01/25 13:04
PHST- 2023/09/11 00:00 [revised]
PHST- 2023/03/07 00:00 [received]
PHST- 2023/12/20 00:00 [accepted]
PHST- 2024/03/28 06:45 [medline]
PHST- 2024/01/25 18:42 [pubmed]
PHST- 2024/01/25 13:04 [entrez]
PHST- 2024/01/25 00:00 [pmc-release]
AID - EHF214670 [pii]
AID - 10.1002/ehf2.14670 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2024 Apr;11(2):1144-1152. doi: 10.1002/ehf2.14670. Epub 2024 Jan 
      25.