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Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure

Huynh, Q ORCID: 0000-0003-1368-5160, Negishi, K ORCID: 0000-0002-9086-2565, De Pasquale, C, Hare, J, Leung, D, Stanton, T and Marwick, TH 2018 , 'Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure' , Medical Journal of Australia , pp. 1-7 , doi: 10.5694/mja17.00809.

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Objectives: To investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes.Design: Cohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF.Main Outcome Measures: All-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission.Results: 58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings.Conclusions: Differences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.

Item Type: Article
Authors/Creators:Huynh, Q and Negishi, K and De Pasquale, C and Hare, J and Leung, D and Stanton, T and Marwick, TH
Keywords: continuity of patient care, delivery of health care, heart failure, managed care programs
Journal or Publication Title: Medical Journal of Australia
Publisher: Australasian Med Publ Co Ltd
ISSN: 0025-729X
DOI / ID Number: 10.5694/mja17.00809
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Copyright 2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.

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