Short-term adjusted outcomes for heart failure

Abstract

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). examined records were 58.202. Crude in-hospital mortality was 9.7%. Thirty-day readmission was 5.1%. The APR-DRG 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.