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Hospital readmissions are increasingly becoming a metric for quality in the current landscape of changing and cost effective medicine. However, no 30-d readmission rates have been established for pediatric cardiac medical patients in the United States. Thus, the objective was to determine 30 d readmission rates and risk factors associated with readmission for pediatric cardiac patients, hypothesizing that pediatric cardiac patients would have significantly higher readmission rates than their general pediatric counterparts.This was a retrospective cohort study.The study took place at a large urban academic children's hospital.The 1124 included patients were discharged from the medical cardiology service and had an unplanned readmission within 30 d during the period of 2012-2014.Admissions, readmissions, diagnoses, demographics, weights, medications, procedures, length of stay, were all measured.There were 1993 visits and 408 (20.5%) 30-d readmissions in our study. Among the 1124 patients, 219 (19.5%) had at least one 30-d readmission. Patient factors associated with increased likelihood of 30-d readmission were younger age (median: 197.5 vs 1365.5 d, P .0001), lower discharge weight (6.2 v 14.5 kg, P .0001) and greater number of diagnoses (P .0001). The encounter factor associated with a 30-d readmission was longer length of stay (4 vs 2 d, P 0.0001). Factors associated with decreased readmissions were having had an electrophysiology procedure during their stay, taking an angiotensin converting enzyme inhibitor/angiotensin receptor blocker or taking an antibiotic.Readmissions within 30 d among pediatric cardiology patients are common. The most common factors associated with readmissions are not likely to be modifiable but may serve as important prognostic indicators and as a basis for counseling.

Many adults with transposition of the great arteries have an anatomic right ventricle functioning as the systemic ventricle and are known to develop congestive heart failure, premature cardiac death, and need for cardiac transplantation. Predictors of poor clinical outcome and functional status in patients with left ventricular failure do not always apply to these patients. We aimed to identify predictors of poor functional status in those patients with a systemic right ventricle.We performed a prospective study of 51 adults with transposition of the great arteries and systemic right ventricles. Demographic, clinical, laboratory, and imaging data were collected, and patients completed a Minnesota Living with Heart Failure Questionnaire (MLHFQ). Comparisons were made between those patients with d-type transposition of the great arteries (dTGA) who have undergone prior atrial switch and those with congenitally corrected transposition (ccTGA). A correlation analysis was performed to identify predictors of poor functional status, as determined by a 6-minute walk distance test.Median age was 30 years (range 19-65). Median B-type natriuretic peptide was 48 pg/mL (range 16-406). There were 27 patients (53%) with moderate-severe right ventricular dysfunction and 10 (20%) with moderate-severe tricuspid valve regurgitation. The median MLHFQ score was 9 (range 0-78) and 6-minute walk test was 510 m (range 231-703). Forty-one patients had a diagnosis of dTGA atrial switch and 11 patients had ccTGA. Patients with ccTGA were significantly older (40 vs. 28 years, P =.004) and had more tricuspid valve regurgitation (P =.02). Despite this, their MLHFQ scores were significantly lower (2.5 vs. 17, P =.04) and they walked further (635 vs. 504 m, P =.02). Predictors of a short 6-minute walk distance included short stature (P =.009) and dTGA (P =.002). The patient's self-assessment of poor health, as measured by an increased New York Heart Association class (P =.003) and a decreased MLHFQ score (P.0001) also correlated. B-type natriuretic peptide levels, right ventricular dysfunction, severity of tricuspid valve regurgitation, need for pacemaker, and clinical signs of heart failure did not correlate with exercise tolerance.Traditional parameters used to predict outcomes in patients with left ventricular failure are not predictive in patients with a systemic right ventricle. Instead, patient's self-assessment of functional status did correlate with objective functional status.