The Effect of Transitional Care on 30-Day Outcomes in Patients Hospitalised With Acute Heart Failure

The Effect of Transitional Care on 30-Day Outcomes in Patients Hospitalised With Acute Heart Failure

Background: Patients admitted to hospital with acute heart failure (AHF) are at increased risk of readmission and mortality post-discharge. The aim of the study was to examine health service utilisation within 30 days post-discharge from an AHF hospitalisation. Methods: This was a prospective, obser...

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Bibliographic Details
Main Authors: Driscoll, A., Dinh, D., Prior, D., Kaye, D., Hare, D., Neil, C., Lockwood, S., Brennan, A., Lefkovits, J., Carruthers, H., Amerena, J., Cooke, J.C., Vaddadi, G., Nadurata, V., Reid, Christopher
Format: Journal Article
Language:English
Published: ELSEVIER SCIENCE INC 2020
Subjects:
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Heart failure
Transitional care
Registry
Mortality
MEDICARE BENEFICIARIES
MANAGEMENT
GUIDELINES
MORTALITY
ADMISSION
TRENDS
Acute Disease
Aged
Female
Heart Failure
Hospital Mortality
Humans
Inpatients
Male
Morbidity
Patient Readmission
Prospective Studies
Risk Factors
Stroke Volume
Survival Rate
Transitional Care
Victoria
Online Access:http://purl.org/au-research/grants/nhmrc/1136372
http://hdl.handle.net/20.500.11937/93776
Description
Summary:Background: Patients admitted to hospital with acute heart failure (AHF) are at increased risk of readmission and mortality post-discharge. The aim of the study was to examine health service utilisation within 30 days post-discharge from an AHF hospitalisation. Methods: This was a prospective, observational, non-randomised study of consecutive patients hospitalised with acute HF to one of 16 Victorian hospitals over a 30-day period each year and followed up for 30 days post-discharge. The project was conducted annually over three consecutive years from 2015 to 2017. Results: Of the 1,197 patients, 56.3% were male with an average age of 77±13.23 years. Over half of the patients (711, 62.5%) were referred to an outpatient clinic and a third (391, 34.4%) to a HF disease management program. In-hospital mortality was 5.1% with 30 day-mortality of 9% and readmission rate of 24.4%. Patients who experienced a subsequent readmission less than 10 days post-discharge and between 11 and 20 days post-discharge had a five- to six-fold increase in risk of mortality (adjusted OR 5.02, 95% CI 2.11–11.97; OR 6.45, 95% CI 2.69–15.42; respectively) compared to patients who were not readmitted to hospital. An outpatient appointment within 30 days post-discharge significantly reduced the risk of 30-day mortality by 81% (95% CI 0.09–0.43). Conclusion: Patients admitted to hospital with AHF who experience a subsequent readmission within 20 days post-discharge are at increased risk of dying. However, early follow-up post-discharge may reduce this risk. Early post-discharge follow-up is vital to address this vulnerable period after a HF admission.

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