Key result
Internal medicine admission for ADHF shows no difference in 30-day readmission versus cardiology.
Why the study?
ADHF admissions to internal medicine departments previously carried higher readmission risk than those to cardiology departments, but it was unknown if this still applied following recent advances in care.
Does admission to internal medicine departments compared to cardiology departments affect 30-day readmission rates in patients with acute decompensated heart failure?
Cohort (n=8,332)
No
Does admission to internal medicine departments compared to cardiology departments affect 30-day readmission rates in patients with acute decompensated heart failure?
Effect estimate: OR 1.0 (95% CI 0.75-1.37)
Absolute Event Rate: 19.6% vs 15.9%
p-value: p=0.96
Patients with ADHF admitted to internal medicine are older with more comorbidities than those admitted to cardiology, but the admitting department itself may not independently drive the higher 30-day readmission rates observed in these patients.
No independent departmental effect on ADHF readmission; leaves open whether selection or unmeasured factors explain unadjusted differences.
AIMS: Efforts are constantly made to decrease the rates of readmission after acute decompensated heart failure (ADHF). ADHF admissions to internal medicine departments (IMD) were previously associated with higher risk for readmission compared with those admitted to cardiology departments (CD). It is unknown if the earlier still applies after recent advancement in care over the last decade. This contemporary cohort compares characteristics and outcomes of ADHF patients admitted to IMD with those admitted to CD. METHODS AND RESULTS: The data for this single-centre, retrospective study utilized a cohort of 8332 ADHF patients admitted between 2007 and 2017. We compared patients' baseline characteristics and clinical and laboratory indices of patients admitted to CD and IMD with the outcome defined as 30 day readmission rate. In comparison with those admitted to CD, patients admitted to IMD (89.5% of patients) were older (79 [70-86] vs. 69 [60-78] years; P < 0.001) and had a higher incidence of co-morbidities and a higher ejection fraction. Readmission rates at 30 days were significantly lower in patients admitted to CD (15.9% vs. 19.6%; P = 0.01). Conflicting results of three statistical models failed to associate between the admitting department and 30 day readmission (odds ratio for 30 day readmission in CD: forced and backward stepwise logistic regression 0.8, 95% confidence interval 0.65-0.97, P = 0.02; stabilized inverse probability weights model odds ratio 1.0, confidence interval 0.75-1.37, P = 0.96). CONCLUSIONS: This contemporary analysis of ADHF patient cohort demonstrates significant differences in the characteristics and outcomes of patients admitted to IMD and CD. Thus, focusing strategies for readmission prevention in patients admitted to IMD may be beneficial.
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Maymon et al. (2020) conducted a cohort in Acute Decompensated Heart Failure (n=8,332). Admission to internal medicine departments vs. Admission to cardiology departments was evaluated on 30 day readmission rate (OR 1.0, 95% CI 0.75-1.37, p=0.96). Admission to internal medicine vs cardiology departments for acute decompensated heart failure showed no independent association with 30-day readmission (OR 1.0; 95% CI 0.75-1.37; P=0.96).
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