Trends in 30-day readmissions following hospitalisation for heart failure by sex, socioeconomic status and ethnicity
| Autor: | C Lawson, H Crothers, S Remsing, I Squire, F Zaccardi, M Davies, L Bernhardt, K Reeves, R Lilford, K Khunti |
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| Rok vydání: | 2021 |
| Předmět: |
Medicine (General)
medicine.medical_treatment ICD Implantable cardioverter defibrillator Age adjustment Heart failure COPD Chronic obstructive pulmonary disease HF Heart failure R5-920 CVD Cardiovascular disease AF Atrial fibrillation medicine PCI Percutaneous coronary intervention Myocardial infarction Socioeconomic status COPD CVA Cerebrovascular accident hospitalisation ONS Office of National Statistics business.industry Percutaneous coronary intervention General Medicine medicine.disease Implantable cardioverter-defibrillator CI Confidence Interval Confidence interval HES Hospital Episode Statistics CRT Cardiac resynchronisation therapy IMD Index of Multiple Deprivation MI Myocardial infarction IHD Ischaemic heart disease business Readmission Research Paper Demography Kidney disease |
| Zdroj: | EClinicalMedicine EClinicalMedicine, Vol 38, Iss, Pp 101008-(2021) |
| ISSN: | 2589-5370 2002-2018 |
| DOI: | 10.1016/j.eclinm.2021.101008 |
| Popis: | Background Reducing the high patient and economic burden of early readmissions after hospitalisation for heart failure (HF) has become a health policy priority of recent years. Methods An observational study linking Hospital Episode Statistics to socioeconomic and death data in England (2002-2018). All first hospitalisations with a primary discharge code for HF were identified. Quasi-poisson models were used to investigate trends in 30-day readmissions by age, sex, socioeconomic status and ethnicity. Findings There were 698,983 HF admissions, median age 81 years [IQR 14]. In-hospital deaths reduced by 0.7% per annum (pa), whilst additional deaths at 30-days remained stable at 5%. Age adjusted 30-day readmissions (21% overall), increased by 1.4% pa (95% CI 1.3-1.5). Readmissions for HF (6%) and ‘other cardiovascular disease (CVD)’ (3%) remained stable, but readmissions for non-CVD causes (12%) increased at a rate of 2.6% (2.4-2.7) pa. Proportions were similar by sex but trends diverged by ethnicity. Black groups experienced an increase in readmissions for HF (1.8% pa, interaction-p 0.03) and South Asian groups had more rapidly increasing readmission rates for non-CVD causes (interaction-p 0.04). Non-CVD readmissions were also more prominent in the least (15%; 15-15) compared to the most affluent group (12%; 12-12). Strongest predictors for HF readmission were Black ethnicity and chronic kidney disease, whilst cardiac procedures were protective. For non-CVD readmissions, strongest predictors were non-CVD comorbidities, whilst cardiologist care was protective. Interpretation In HF, despite readmission reduction policies, 30-day readmissions have increased, impacting the least affluent and ethnic minority groups the most. Funding NIHR. |
| Databáze: | OpenAIRE |
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