TY - JOUR
T1 - Multimorbidity and the risk of all cause 30-day readmission in the setting of multidisciplinary management of chronic heart failure
T2 - A retrospective analysis of 830 hospitalized patients in Australia
AU - Wiley, Joshua F.
AU - Chan, Yih-Kai
AU - Ahamed, Yasmin
AU - Ball, Jocasta
AU - Carrington, Melinda J.
AU - Riegel, Barbara
AU - Stewart, Simon
PY - 2018/9
Y1 - 2018/9
N2 - BACKGROUND:: Multimorbidity has an adverse effect on health outcomes in hospitalized individuals with chronic heart failure (CHF), but the modulating effect of multidisciplinary management is unknown. OBJECTIVE:: The aim of this study was to test the hypothesis that increasing morbidity would independently predict an increasing risk of 30-day readmission despite multidisciplinary management of CHF. METHODS:: We studied patients hospitalized for any reason with heart failure receiving nurse-led, postdischarge multidisciplinary management. We profiled a matrix of expected comorbidities involving the most common coexisting conditions associated with CHF and examined the relationship between multimorbidity and 30-day all-cause readmission. RESULTS:: A total of 830 patients (mean age 73 ± 13 years and 65% men) were assessed. Multimorbidity was common, with an average of 6.6 ± 2.4 comorbid conditions with sex-based differences in prevalence of 4 of 10 conditions. Within 30 days of initial hospitalization, 216 of 830 (26%) patients were readmitted for any reason. Greater multimorbidity was associated with increasing readmission (4%–44% for those with 0–1 to 8–9 morbid conditions; adjusted odds ratio, 1.25; 95% confidence interval, 1.13–1.38) for each additional condition. Three distinct classes of patient emerged: class 1—diabetes, metabolic, and mood disorders; class 2—renal impairment; and class 3—low with relatively fewer comorbid conditions. Classes 1 and 2 had higher 30-day readmission than class 3 did (adjusted P < .01 for both comparisons). CONCLUSIONS:: These data affirm that multimorbidity is common in adult CHF inpatients and in potentially distinct patterns linked to outcome. Overall, greater multimorbidity is associated with a higher risk of 30-day all-cause readmission despite high-quality multidisciplinary management. More innovative approaches to target-specific clusters of multimorbidity are required to improve health outcomes in affected individuals.
AB - BACKGROUND:: Multimorbidity has an adverse effect on health outcomes in hospitalized individuals with chronic heart failure (CHF), but the modulating effect of multidisciplinary management is unknown. OBJECTIVE:: The aim of this study was to test the hypothesis that increasing morbidity would independently predict an increasing risk of 30-day readmission despite multidisciplinary management of CHF. METHODS:: We studied patients hospitalized for any reason with heart failure receiving nurse-led, postdischarge multidisciplinary management. We profiled a matrix of expected comorbidities involving the most common coexisting conditions associated with CHF and examined the relationship between multimorbidity and 30-day all-cause readmission. RESULTS:: A total of 830 patients (mean age 73 ± 13 years and 65% men) were assessed. Multimorbidity was common, with an average of 6.6 ± 2.4 comorbid conditions with sex-based differences in prevalence of 4 of 10 conditions. Within 30 days of initial hospitalization, 216 of 830 (26%) patients were readmitted for any reason. Greater multimorbidity was associated with increasing readmission (4%–44% for those with 0–1 to 8–9 morbid conditions; adjusted odds ratio, 1.25; 95% confidence interval, 1.13–1.38) for each additional condition. Three distinct classes of patient emerged: class 1—diabetes, metabolic, and mood disorders; class 2—renal impairment; and class 3—low with relatively fewer comorbid conditions. Classes 1 and 2 had higher 30-day readmission than class 3 did (adjusted P < .01 for both comparisons). CONCLUSIONS:: These data affirm that multimorbidity is common in adult CHF inpatients and in potentially distinct patterns linked to outcome. Overall, greater multimorbidity is associated with a higher risk of 30-day all-cause readmission despite high-quality multidisciplinary management. More innovative approaches to target-specific clusters of multimorbidity are required to improve health outcomes in affected individuals.
KW - chronic heart failure
KW - disease management
KW - multimorbidity
KW - premature readmission
UR - http://www.scopus.com/inward/record.url?scp=85009953620&partnerID=8YFLogxK
U2 - 10.1097/JCN.0000000000000391
DO - 10.1097/JCN.0000000000000391
M3 - Article
C2 - 28107252
AN - SCOPUS:85009953620
SN - 0889-4655
VL - 33
SP - 437
EP - 445
JO - Journal of Cardiovascular Nursing
JF - Journal of Cardiovascular Nursing
IS - 5
ER -