1. Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study
- Author
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Ranasinghe, Isuru, Wang, Yongfei, Dharmarajan, Kumar, Hsieh, Angela F., Bernheim, Susannah M., and Krumholz, Harlan M.
- Subjects
Heart attack -- Care and treatment ,Bacterial pneumonia -- Care and treatment ,Hospital care -- Comparative analysis ,Pneumonia -- Care and treatment ,Heart failure -- Research -- Comparative analysis -- Care and treatment ,Biological sciences - Abstract
Background: Patients aged ≥ 65 years are vulnerable to readmissions due to a transient period of generalized risk after hospitalization. However, whether young and middle-aged adults share a similar risk pattern is uncertain. We compared the rate, timing, and readmission diagnoses following hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among patients aged 18-64 years with patients aged ≥ 65 years. Methods and Findings: We used an all-payer administrative dataset from California consisting of all hospitalizations for HF (n = 206,141), AMI (n = 107,256), and pneumonia (n = 199,620) from 2007-2009. The primary outcomes were unplanned 30- day readmission rate, timing of readmission, and readmission diagnoses. Our findings show that the readmission rate among patients aged 18-64 years exceeded the readmission rate in patients aged ≥ 65 years in the HF cohort (23.4% vs. 22.0%, p < 0.001), but was lower in the AMI (11.2% vs. 17.5%, p < 0.001) and pneumonia (14.4% vs. 17.3%, p < 0.001) cohorts. When adjusted for sex, race, comorbidities, and payer status, the 30-day readmission risk in patients aged 18-64 years was similar to patients ≥ 65 years in the HF (HR 0.99; 95%CI 0.97-1.02) and pneumonia (HR 0.97; 95%CI 0.94- 1.01) cohorts and was marginally lower in the AMI cohort (HR 0.92; 95%CI 0.87-0.96). For all cohorts, the timing of readmission was similar; readmission risks were highest between days 2 and 5 and declined thereafter across all age groups. Diagnoses other than the index admission diagnosis accounted for a substantial proportion of readmissions among age groups < 65 years; a non-cardiac diagnosis represented 39-44% of readmissions in the HF cohort and 37-45% of readmissions in the AMI cohort, while a non-pulmonary diagnosis represented 61-64% of patients in the pneumonia cohort. Conclusion: When adjusted for differences in patient characteristics, young and middle-aged adults have 30-day readmission rates that are similar to elderly patients for HF, AMI, and pneumonia. A generalized risk after hospitalization is present regardless of age., Introduction Reducing readmissions is a key focus of current health policy initiatives in the United States (US). The scope of the problem among elderly individuals is well established--one in five [...]
- Published
- 2014
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