Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study
Kumar Dharmarajan,Angela F. Hsieh,Vivek T. Kulkarni,Zhenqiu Lin,Joseph S. Ross,Leora I. Horwitz,Nancy Kim,Lisa G. Suter,Haiqun Lin,Sharon-Lise T. Normand,Harlan M. Krumholz +10 more
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TLDR
Risk declines slowly for older patients after hospitalization for heart failure, acute myocardial infarction, or pneumonia and is increased for months, but knowledge of absolute risks and their changes over time can be used to better align interventions designed to reduce adverse outcomes after discharge with the highest risk periods for patients.Abstract:
Objective To characterize the absolute risks for older patients of readmission to hospital and death in the year after hospitalization for heart failure, acute myocardial infarction, or pneumonia.
Design Retrospective cohort study.
Setting 4767 hospitals caring for Medicare fee for service beneficiaries in the United States, 2008-10.
Participants More than 3 million Medicare fee for service beneficiaries, aged 65 years or more, surviving hospitalization for heart failure, acute myocardial infarction, or pneumonia.
Main outcome measures Daily absolute risks of first readmission to hospital and death for one year after discharge. To illustrate risk trajectories, we identified the time required for risks of readmission to hospital and death to decline 50% from maximum values after discharge; the time required for risks to approach plateau periods of minimal day to day change, defined as 95% reductions in daily changes in risk from maximum daily declines after discharge; and the extent to which risks are higher among patients recently discharged from hospital compared with the general elderly population.
Results Within one year of hospital discharge, readmission to hospital and death, respectively, occurred following 67.4% and 35.8% of hospitalizations for heart failure, 49.9% and 25.1% for acute myocardial infarction, and 55.6% and 31.1% for pneumonia. Risk of first readmission had declined 50% by day 38 after hospitalization for heart failure, day 13 after hospitalization for acute myocardial infarction, and day 25 after hospitalization for pneumonia; risk of death declined 50% by day 11, 6, and 10, respectively. Daily change in risk of first readmission to hospital declined 95% by day 45, 38, and 45; daily change in risk of death declined 95% by day 21, 19, and 21. After hospitalization for heart failure, acute myocardial infarction, or pneumonia, the magnitude of the relative risk for hospital admission over the first 90 days was 8, 6, and 6 times greater than that of the general older population; the relative risk of death was 11, 8, and 10 times greater.
Conclusions Risk declines slowly for older patients after hospitalization for heart failure, acute myocardial infarction, or pneumonia and is increased for months. Specific risk trajectories vary by discharge diagnosis and outcome. Patients should remain vigilant for deterioration in health for an extended time after discharge. Health providers can use knowledge of absolute risks and their changes over time to better align interventions designed to reduce adverse outcomes after discharge with the highest risk periods for patients.read more
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Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation☆
Brian F. Gage,Amy D. Waterman,William D. Shannon,Michael Boechler,Michael W. Rich,Martha J. Radford +5 more
TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
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Epidemiology of heart failure.
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Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study
Clare J Taylor,José M Ordóñez-Mena,Andrea K Roalfe,Sarah Lay-Flurrie,Nicholas R Jones,Tom Marshall,FD Richard Hobbs +6 more
TL;DR: Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer.
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Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta‐analysis
Harriette G.C. Van Spall,Harriette G.C. Van Spall,Tahseen Rahman,Oliver T Mytton,Chinthanie Ramasundarahettige,Quazi Ibrahim,Conrad Kabali,Michiel Coppens,R. Brian Haynes,Stuart J. Connolly +9 more
TL;DR: To compare the effectiveness of transitional care services in decreasing all‐cause death and all-cause readmissions following hospitalization for heart failure (HF) with conventional care, a large number of patients were admitted to hospital with a history of heart failure.
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The Prevention of Hospital Readmissions in Heart Failure
Boback Ziaeian,Gregg C. Fonarow +1 more
TL;DR: The following review will discuss the interventions found to reduce readmissions for patients and improve hospital performance on the 30-day readmission process measure.
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Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation
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TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
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