Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission.
Claire M DuflosPénélope TroudeDavid StrainchampsChristophe SégouinDamien LogeartGrégoire MercierPublished in: Scientific reports (2020)
In patients with heart failure, some organizational and modifiable factors could be prognostic factors. We aimed to assess the association between the in-hospital care pathways during hospitalization for acute heart failure and the risk of readmission. This retrospective study included all elderly patients who were hospitalized for acute heart failure at the Universitary Hospital Lariboisière (Paris) during 2013. We collected the wards attended, length of stay, admission and discharge types, diagnostic procedures, and heart failure discharge treatment. The clinical factors were the specific medical conditions, left ventricular ejection fraction, type of heart failure syndrome, sex, smoking status, and age. Consistent groups of in-hospital care pathways were built using an ascending hierarchical clustering method based on a primary components analysis. The association between the groups and the risk of readmission at 1 month and 1 year (for heart failure or for any cause) were measured via a count data model that was adjusted for clinical factors. This study included 223 patients. Associations between the in-hospital care pathway and the 1 year-readmission status were studied in 207 patients. Five consistent groups were defined: 3 described expected in-hospital care pathways in intensive care units, cardiology and gerontology wards, 1 described deceased patients, and 1 described chaotic pathways. The chaotic pathway strongly increased the risk (p = 0.0054) of 1 year readmission for acute heart failure. The chaotic in-hospital care pathway, occurring in specialized wards, was associated with the risk of readmission. This could promote specific quality improvement actions in these wards. Follow-up research projects should aim to describe the processes causing the generation of chaotic pathways and their consequences.
Keyphrases
- acute heart failure
- heart failure
- healthcare
- ejection fraction
- quality improvement
- prognostic factors
- palliative care
- end stage renal disease
- left ventricular
- aortic stenosis
- newly diagnosed
- chronic kidney disease
- acute care
- peritoneal dialysis
- affordable care act
- pain management
- adverse drug
- intensive care unit
- atrial fibrillation
- patient safety
- machine learning
- patient reported outcomes
- hypertrophic cardiomyopathy
- aortic valve
- pulmonary artery
- coronary artery disease
- cardiac resynchronization therapy
- chronic pain
- combination therapy
- health insurance
- case report