Journal article
Thirty-Day Readmission Rate in Acute Heart Failure Patients Discharged Against Medical Advice in a Matched Cohort Study
Mayo Clinic proceedings, v 93(10), pp 1397-1403
01 Oct 2018
PMID: 30005815
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: To determine the readmission rate in patients with acute heart failure (AHF) discharged against medical advice (AMA).
Methods: We performed a retrospective analysis using the 2014 National Readmission Database. Patients admitted with a primary diagnosis of AHF were selected. Only those discharged to home and who left AMA were included in the study. The primary outcome was 30-day readmission. We compared the readmission rates among those discharged AMA vs routinely discharged patients using propensity score matching (PSM) to address imbalance in variables between the 2 groups. We matched 3 routinely discharged patients to 1 patient who left AMA.
Results: We identified 273,489 patients with AHF, of whom 116,869 qualified for further study analysis. A total of 2014 patients (1.7%) were in the AMA group and 114,855 (98.3%) were in the routinely discharged group. After PSM, 6042 routinely discharged patients were matched with 2014 patients from the AMA group. The standard mean difference for each variable was less than 10% post-matching. The 30-day readmission rate among those who left AMA was higher than among those routinely discharged (33% vs 20.1%; P<.001). Heart failure (44.8%) was the most common cause of readmission in the AMA group. Patients who left AMA were more likely to be readmitted to a different hospital compared with those routinely discharged (37.4 vs 23.1%; P<.001). They also had a high rate of leaving AMA during the readmission (18 vs 2%; P<.001).
Conclusion: Patients with AHF discharged AMA had a significantly higher 30-day readmission rate than did the routinely discharged group. (C) 2018 Mayo Foundation foe Medical Education and Research
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Details
- Title
- Thirty-Day Readmission Rate in Acute Heart Failure Patients Discharged Against Medical Advice in a Matched Cohort Study
- Creators
- Brijesh Patel - Lehigh Valley Hosp Network, Dept Cardiol, Allentown, PA USAGeorge Prousi - Lehigh Valley Hosp Network, Dept Internal Med, Allentown, PA USAMahel Shah - Lehigh Valley Hosp Network, Dept Cardiol, Allentown, PA USAPaul Secheresiu - Lehigh Valley Hosp Network, Dept Internal Med, Allentown, PA USALohit Garg - Lehigh Valley Hospital-PoconoManyoo Agarwal - University of Tennessee Health Science CenterShantanu Patil - SSM Hlth St Marys Hosp, Dept Med, St Louis, MO USARahul Gupta - New York Medical CollegeBruce Feldman - Lehigh Valley Hospital-Pocono
- Publication Details
- Mayo Clinic proceedings, v 93(10), pp 1397-1403
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- 1573007 / Dorothy Rider Pool Trust Fund
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000446070100010
- Scopus ID
- 2-s2.0-85049562200
- Other Identifier
- 991022160507204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems