Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Hospital readmission among older adults with congestive heart failure

Tasneem Islam A E , Beverly O’Connell B C and Prabha Lakhan A D
+ Author Affiliations
- Author Affiliations

A Deakin–Southern Health Nursing Research Centre, Locked Bag 29, Clayton South, Vic. 3169, Australia.

B School of Nursing, Deakin University, 221 Burwood Highway, Burwood, Vic. 3135, Australia.

C Faculty of Nursing, University of Manitoba, 217 Helen Glass Centre, Winnipeg, Manitoba R3T 2N2, Canada.

D Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: p.ramritu@uq.edu.au

E Corresponding author. Email: tislam@deakin.edu.au

Australian Health Review 37(3) 362-368 https://doi.org/10.1071/AH12042
Submitted: 30 August 2012  Accepted: 30 January 2013   Published: 24 May 2013

Abstract

Introduction. To examine the factors associated with unplanned readmission among older adults with congestive heart failure (CHF) within 28 days of discharge from an index admission, within a large Australian health service.

Methods. Using a comparative cohort design, a multivariate logistic regression model was used to compare readmitted patients with non-readmitted patients and identify risk factors associated with readmission.

Results. Significant risk factors identified were male gender, numerous diagnoses, length of stay 3 days or longer and patients being admitted from acute, subacute or aged-care facilities.

Conclusions. The high risk of patients being readmitted from acute, subacute and aged-care services requires further review as these readmissions may be avoidable. It may also be useful to develop a readmission risk screening tool so that patients at risk of readmission can be identified.

What is known about this topic? Older adults with CHF are likely to experience multiple readmissions to hospital. There have been several studies conducted on hospital readmissions; however, generalising the findings is problematic due to the use of variable definitions of what constitutes a readmission.

What does this paper add? This paper addresses the absence of Australian research comparing groups of older patients with CHF who are readmitted to hospital with those who are not readmitted. It also adopts one of the more frequently used definitions of readmission to aid in future comparability of research.

What are the implications for practice? Further work is necessary to improve discharge planning and effectively manage chronic illnesses such as CHF in patients’ homes. It may be useful to develop a readmission risk screening tool for staff of inpatient medical wards so that these at-risk patients can be identified before discharge.


References

[1]  Calver J, Brameld KJ, Preen DB, Alexia SJ, Boldy DP, McCaul KA. High-cost users of hospital beds in Western Australia: a population-based record linkage study. Med J Aust 2006; 184 393–7.
| 16618238PubMed |

[2]  Hoyt RE, Bowling LS. Reducing readmissions for congestive heart failure. Am Fam Physician 2001; 63 1593–8.
| 1:STN:280:DC%2BD3M3kvFGktQ%3D%3D&md5=86ecb8849a33ff2f034cf3b88c0659a0CAS | 11327436PubMed |

[3]  Field B. Heart failure. What of the future? Bulletin no. 6. Canberra: Australian Institute of Health and Welfare; 2003.

[4]  National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Guidelines for the prevention, detection and management of chronic heart failure in Australia. Mawson: National Heart Foundation of Australia; 2011.

[5]  Clark RA, McLennan S, Dawson A, Wilkinson D, Stewart S. Uncovering a hidden epidemic: a study of the current burden of heart failure in australia. Heart Lung Circ 2004; 13 266–73.
Uncovering a hidden epidemic: a study of the current burden of heart failure in australia.Crossref | GoogleScholarGoogle Scholar | 16352206PubMed |

[6]  Fletcher L, Thomas D. Congestive heart failure: understanding the pathophysiology and management. J Am Acad Nurse Pract 2001; 13 249–57.
Congestive heart failure: understanding the pathophysiology and management.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD387pslyltg%3D%3D&md5=5f55377d61ef16889a299a9cf6e512edCAS | 11930867PubMed |

[7]  Abhayaratna WP, Smith WT, Becker NG, Marwick TH, Jeffery IM, McGill DA. Prevalence of heart failure and systolic ventricular dysfunction in older Australians: the Canberra Heart Study. MJA 2006; 184 151–4.
| 16489896PubMed |

[8]  Ashton CM, Kuykendall DH, Johnson ML, Wray NP, Wu L. The association between the quality of inpatient care and early readmission. Ann Intern Med 1995; 122 415–21.
| 1:STN:280:DyaK2M7mtVertw%3D%3D&md5=6ad56088787931896c2600c7f59e39e7CAS | 7856989PubMed |

[9]  Clarke A. Are readmissions avoidable? BMJ 1990; 301 1136–8.
Are readmissions avoidable?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M%2FntVWjsQ%3D%3D&md5=fdb3a532c7ecd25dd4fcf455aa50b45eCAS | 2252925PubMed |

[10]  Guo L, Chung ES, Casey DE, Snow R. Redefining hospital readmissions to better reflect clinical course of care for heart failure patients. Am J Med Qual 2007; 22 98–102.
Redefining hospital readmissions to better reflect clinical course of care for heart failure patients.Crossref | GoogleScholarGoogle Scholar |

[11]  Hasan M. Readmission of patients to hospital: still ill defined and poorly understood. Int J Qual Health Care 2001; 13 177–9.
Readmission of patients to hospital: still ill defined and poorly understood.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2Fis1WntQ%3D%3D&md5=671f4c725cf6a8812ff72154f0144dfaCAS | 11476140PubMed |

[12]  Ruiz B, García M, Aguirre U, Aguirre C. Factors predicting hospital readmissions related to adverse drug reactions. Eur J Clin Pharmacol 2008; 64 715–22.
Factors predicting hospital readmissions related to adverse drug reactions.Crossref | GoogleScholarGoogle Scholar | 18385990PubMed |

[13]  Shalchi Z, Saso S, Li HK, Rowlandson E, Tennant RC. Factors influencing hospital readmission rates after acute medical treatment. Clin Med 2009; 9 426–30.
| 1:STN:280:DC%2BD1MjjsFyisg%3D%3D&md5=eda4b67eade14249fdb425279ac0e6dbCAS | 19886100PubMed |

[14]  Babayan ZV, McNamara RL, Nagajothi N, Kasper EK, Armenian HK, Powe NR, et al Predictors of cause-specific hospital readmission in patients with heart failure. Clin Cardiol 2003; 26 411–8.
Predictors of cause-specific hospital readmission in patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 14524597PubMed |

[15]  Ross JS, Mulvey GK, Stauffer B, Patlolla V, Bernheim SM, Keenan PS, et al Statistical models and patient predictors of readmission for heart failure: a systematic review. Arch Intern Med 2008; 168 1371–86.
Statistical models and patient predictors of readmission for heart failure: a systematic review.Crossref | GoogleScholarGoogle Scholar | 18625917PubMed |

[16]  Hamner JB, Ellison KJ. Predictors of hospital readmission after discharge in patients with congestive heart failure. Heart Lung 2005; 34 231–9.
Predictors of hospital readmission after discharge in patients with congestive heart failure.Crossref | GoogleScholarGoogle Scholar | 16027642PubMed |

[17]  Philbin EF, DiSalvo TG. Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data. J Am Coll Cardiol 1999; 33 1560–6.
Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3msFGqsQ%3D%3D&md5=64e04cc572492ecec214089a80129fc1CAS | 10334424PubMed |

[18]  Chu LW, Pei CK. Risk factors for early emergency hospital readmission in elderly medical patients. Gerontology 1999; 45 220–6.
Risk factors for early emergency hospital readmission in elderly medical patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1Mzitlyqtw%3D%3D&md5=801c36526215ff76c064bd4b35b58c54CAS | 10394080PubMed |

[19]  Landi F, Onder G, Cesari M, Barillaro C, Lattanzio F, Carbonin PU, et al Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol 2004; 57 832–6.
Comorbidity and social factors predicted hospitalization in frail elderly patients.Crossref | GoogleScholarGoogle Scholar | 15551473PubMed |

[20]  Philbin EF, Dec GW, Jenkins PL, DiSalvo TG. Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol 2001; 87 1367–71.
Socioeconomic status as an independent risk factor for hospital readmission for heart failure.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzivFCltA%3D%3D&md5=4f842dfa58a25a9d12daca1357bd80f1CAS | 11397355PubMed |

[21]  Rathore SS, Masoudi FA, Wang Y, Curtis JP, Foody JM, Havranek EP, et al Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project. Am Heart J 2006; 152 371–8.
Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project.Crossref | GoogleScholarGoogle Scholar | 16875925PubMed |

[22]  Schwarz KA, Elman CS. Identification of factors predictive of hospital readmissions for patients with heart failure. Heart Lung 2003; 32 88–99.
Identification of factors predictive of hospital readmissions for patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 12734531PubMed |

[23]  Evangelista LS, Doering LV, Dracup K. Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans. Am J Cardiol 2000; 86 1339–42.
Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FpvFymtw%3D%3D&md5=f7b50033965b952a215c698902475023CAS | 11113409PubMed |

[24]  Jiang W, Alexander J, Christopher E, Kuchibhatla M, Gaulden LH, Blazing MA, et al Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 2001; 161 1849
Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvotFKisA%3D%3D&md5=27e5a59f0f00510f096fd7ca7fab1cd5CAS | 11493126PubMed |

[25]  Rodríguez-Artalejo F, Guallar-Castillón P, Herrera MC, Otero CM, Chiva MO, Ochoa CC, et al Social network as a predictor of hospital readmission and mortality among older patients with heart failure. J Card Fail 2006; 12 621–7.
Social network as a predictor of hospital readmission and mortality among older patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 17045181PubMed |

[26]  Weaver C, Schiech L, Held-Warmkessel J, Kedziera P, Haney E, DiLullo G, et al Risk for unplanned hospital readmission of patients with cancer: results of a retrospective medical record review. Oncol Nurs Forum 2006; 33 E44–52.
Risk for unplanned hospital readmission of patients with cancer: results of a retrospective medical record review.Crossref | GoogleScholarGoogle Scholar | 16676008PubMed |

[27]  Afzal A, Ananthasubramaniam K, Sharma N, al-Malki Q, Ali AS, Jacobsen G, et al Racial differences in patients with heart failure. Clin Cardiol 1999; 22 791–4.
Racial differences in patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FptFGhtA%3D%3D&md5=4a5806e1bd1c75cb740424e0989bb34bCAS | 10626081PubMed |

[28]  Alexander M, Grumbach K, Remy L, Rowell R, Massie BM. Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. Am Heart J 1999; 137 919–27.
Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3jvVKhsg%3D%3D&md5=b01ca27be510946e1866cd26138f0085CAS | 10220642PubMed |

[29]  Philbin EF, DiSalvo TG. Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure. Am J Cardiol 1998; 82 76–81.
Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czjsVSrug%3D%3D&md5=a35d95b02d5b8d26f65bd7763c6788a2CAS | 9671013PubMed |

[30]  Sherer AP, Crane PB, Abel WM. Predictors of emergency department admissions for heart failure. Heart Lung J Acute Crit Care 2012; 41 418
Predictors of emergency department admissions for heart failure.Crossref | GoogleScholarGoogle Scholar |

[31]  McDermott MM, Feinglass J, Lee PI, Mehta S, Schmitt B, Lefevre F, et al Systolic function, readmission rates, and survival among consecutively hospitalized patients with congestive heart failure. Am Heart J 1997; 134 728–36.
Systolic function, readmission rates, and survival among consecutively hospitalized patients with congestive heart failure.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2Fht1WjtA%3D%3D&md5=3104027b5fa17130c937c799e6a1b357CAS | 9351741PubMed |

[32]  Morrissey EFR, McElnay JC, Scott M, McConnell BJ. Influence of drugs, demographics and medical history on hospital readmission of elderly patients: a predictive model. Clin Drug Investig 2003; 23 119–28.
Influence of drugs, demographics and medical history on hospital readmission of elderly patients: a predictive model.Crossref | GoogleScholarGoogle Scholar |

[33]  Westert GP, Lagoe RJ, Keskimäki I, Leyland A, Murphy M. An international study of hospital readmissions and related utilization in Europe and the USA. Health Policy 2002; 61 269–78.
An international study of hospital readmissions and related utilization in Europe and the USA.Crossref | GoogleScholarGoogle Scholar | 12098520PubMed |

[34]  Rockwood K, Mitnitski As. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 2011; 27 17–26.
Frailty defined by deficit accumulation and geriatric medicine defined by frailty.Crossref | GoogleScholarGoogle Scholar | 21093719PubMed |

[35]  Caplan GA, Brown A, Croker WD, Doolan J. Risk of admission within 4 weeks of discharge of elderly patients from the emergency department–the DEED study. Discharge of elderly from emergency department. Age Ageing 1998; 27 697–702.
Risk of admission within 4 weeks of discharge of elderly patients from the emergency department–the DEED study. Discharge of elderly from emergency department.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzjsFWnug%3D%3D&md5=3d1c67724d380860e4e14ae673371794CAS | 10408663PubMed |

[36]  Balla U, Malnick S, Schattner A. Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems. Medicine 2008; 87 294–300.
Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems.Crossref | GoogleScholarGoogle Scholar | 18794712PubMed |

[37]  Chambers M, Clarke A. Measuring readmission rates. BMJ 1990; 301 1134–6.
Measuring readmission rates.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M%2FntVWjsA%3D%3D&md5=16674bd0107e7f0ef74c148e37a63e34CAS | 2132558PubMed |

[38]  Lagoe RJ, Noetscher CM, Hohner VK, Schmidt GM. Analyzing hospital readmissions using statewide discharge databases. J Nurs Care Qual 1999; 13 57–67.
Analyzing hospital readmissions using statewide discharge databases.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MvgsFGnsg%3D%3D&md5=1c122173514f422f19303eb6b85c7167CAS | 10476625PubMed |

[39]  Australian Council on Healthcare Standards. Australasian clinical indicator report 2001–2009: determining the potential to improve quality of care. Ultimo: Australian Council on Healthcare Standards; 2010.

[40]  Australian Government. National statement on ethical conduct in human research. Canberra: Australian Government; 2007.

[41]  Malki Q, Sharma ND, Afzal A, Ananthsubramaniam K, Abbas A, Jacobson G, et al Clinical presentation, hospital length of stay, and readmission rate in patients with heart failure with preserved and decreased left ventricular systolic function. Clin Cardiol 2002; 25 149–52.
Clinical presentation, hospital length of stay, and readmission rate in patients with heart failure with preserved and decreased left ventricular systolic function.Crossref | GoogleScholarGoogle Scholar | 12000071PubMed |

[42]  Kirby SE, Dennis SM, Jayasinghe UW, Harris MF. Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice. BMC Health Serv Res 2010; 10 216–23.
Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice.Crossref | GoogleScholarGoogle Scholar | 20663141PubMed |

[43]  Vaccarino V, Chen YT, Wang Y, Radford MJ, Krumholz HM. Sex differences in the clinical care and outcomes of congestive heart failure in the elderly. Am Heart J 1999; 138 835–42.
Sex differences in the clinical care and outcomes of congestive heart failure in the elderly.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FgslGguw%3D%3D&md5=c61c57ca5c45a7b8812ff49b588a9ad5CAS | 10539813PubMed |

[44]  Dobrzanska L, Newell R. Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factors. J Clin Nurs 2006; 15 599–606.
Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factors.Crossref | GoogleScholarGoogle Scholar | 16629969PubMed |

[45]  Lyratzopoulos G, Havely D, Gemmell I, Cook GA. Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study. BMC Emerg Med 2005; 5 1–9.
Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study.Crossref | GoogleScholarGoogle Scholar | 15663793PubMed |

[46]  Blair AS, Lloyd-Williams F, Mair FS. What do we know about socioeconomic status and congestive heart failure? A review of the literature. J Fam Pract 2002; 51 169
| 11978216PubMed |

[47]  Gonseth J, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J 2004; 25 1570–95.
The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports.Crossref | GoogleScholarGoogle Scholar | 15351157PubMed |

[48]  Gwadry-Sridhar FH, Flintoft V, Lee DS, Lee H, Guyatt GH. A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure. Arch Intern Med 2004; 164 2315–20.
A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 15557409PubMed |

[49]  Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: A meta-analysis. JAMA 2004; 291 1358–67.
Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: A meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXitlKntrk%3D&md5=55745f26f6099dd6ee0e564a30572062CAS | 15026403PubMed |