Frequency, characteristics and prognostic impact of hospital readmissions in elderly patients with heart failure: A population study from 2013 to 2017 in Liguria, Northern Italy. (15th September 2022)

• Record Type: Journal Article
• Authors: Canepa, Marco; Leporatti, Lucia; Persico, Luca; Ameri, Pietro; Porto, Italo; Ansaldi, Filippo; Montefiori, Marcello
• Is Part Of: International journal of cardiology. Volume 363(2022)
• Page Start: 111
• Page End: 118
• Publication Date: 2022-09-15
• Subjects: Heart failure -- Elderly -- Readmission -- Hospitalization -- Comorbidity -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.06.052
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Hospital readmissions are a key determinant of prognosis in elderly patients with heart failure (HF). We investigated their frequency, predictors and prognostic impact using a large administrative database from Liguria, the oldest region of Italy. Methods: Patients aged ≥18 years with at least one hospitalization with HF and being prescribed a diuretic medication between January 2013 and December 2017 were included in the analysis. Their demographics and Charlson comorbidity index (CCI) were collected. Patients were grouped by number of readmissions, and negative binomial and Cox proportional hazard models were used to explore independent predictors of readmissions and mortality, respectively. Results: There were 207, 130 hospital admissions from 35, 316 patients (mean age 81.6 years, 43.7% ≥85 years of age, 47.2% male, mean CCI 1.7, overall mortality 52.8%). About a quarter of patients (8.878, 25.1%) had more than eight readmissions during follow-up, for a total of 108.146 admissions (52.2% of admissions). Male gender, lower educational level and higher CCI were independently associated with increased number of readmissions and increased mortality. There was an independent inverse relationship between number of admissions and survival, with patients hospitalized 8 or more times displaying a 3-fold increase in mortality, and a significant interaction between older age and readmissions on mortality. Conclusion: A quarter of older comorbid HF patients contributed to more than half of HF hospital readmissions recorded over a 5-year period in Liguria, with a dismal impact on prognosis. Aging societies should pay greater attention to this matter and personalized disease-management programs should be implemented. Highlights: A quarter of older comorbid HF patients contributed to more than half of HF hospital readmissions over a 5-year period in Liguria, the oldest region of Italy. Readmissions were increasingly related to non-cardiovascular causes, and directly associated with an increasing number of comorbidities. An increased number of readmissions was independently associated with an exponential increase in overall mortality, especially at older ages.