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.
Heart failure, In-hospital mortality, Patient readmission, Quality improvement
Financial support: No grants or funding have been received for this
study.
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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Cardiovascular medicine continues to advance at a remarkable pace, driven by innovation, interdisciplinary collaboration and an ever-deepening understanding of disease mechanisms. As patient populations age and chronic conditions become increasingly complex, the field stands at the intersection of precision therapy, digital health and preventive strategy. This winter issue of Heart International reflects that transformation, highlighting […]
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