Short-term adjusted outcomes for heart failure
Abstract
Overview
Purpose. Heart failure (HF) is recognized as a major problem in industrialized countries. Short-term adjusted outcomes
are indicators of quality for care process during/after hospitalization. Our aim is to evaluate, for patients
with principal diagnosis of HF, in-hospital mortality and 30-day readmissions for all-causes using two different risk
adjustment (RA) tools.
Methods and Results. We used data from the hospital discharge abstract (HD) of a retrospective cohort of patients
(2002-2007) admitted in Tuscan hospitals, Italy. Considered outcomes were in-hospital mortality and readmission
at 30 days. We compared the All-Patients Refined Diagnosis Related Groups (APR-DRG) system and the
Elixhauser Index (EI). Logistic regression was performed and models were compared using the C statistic (C). The
examined records were 58.202. Crude in-hospital mortality was 9.7%. Thirty-day readmission was 5.1%. The APRDRG
class of risk of death (ROD) was a predictive factor for in-hospital mortality; the APR-DRG class of severity
was not significantly associated with 30-day readmissions (P>0.05). EI comorbidities which were more strongly
associated with outcomes were nonmetastatic cancer for in-hospital mortality (odds ratio, OR 2.25, P<0.001),
uncomplicated and complicated diabetes for 30-day hospital readmissions (OR 1.20 and 1.34, P<0.001). The discriminative
abilities for in-hospital mortality were sufficient for both models (C 0.67 for EI, C 0.72 for APR-DRG)
while they were low for 30-day readmissions rate (C 0.53 and 0.52).
Conclusions. Age, gender, APR-DRG ROD and some Elixhauser comorbidities are predictive factors of outcomes;
only the APR-DRG showed an acceptable ability to predict hospital mortality while none of them was satisfactory
in predicting the readmissions within 30 days.
Keywords
Heart failure, In-hospital mortality, Patient readmission, Quality improvement
Article Information
Disclosure
Financial support: No grants or funding have been received for this
study.
Correspondence
Gabriele Messina Department of Molecular and Developmental Medicine Area of Public Health University of Siena Via Aldo Moro 2 53100 Siena, Italy gabriele.messina@unisi.it
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