Multimorbidity and the risk of all-cause 30-day readmission in the setting of multidisciplinary management of chronic heart failure: A retrospective analysis of 830 hospitalized patients in Australia
Journal article
Wiley, Joshua F., Chan, Yih-Kai, Ahamed, Yasmin, Ball, Jocasta, Carrington, Melinda J., Reigel, Barbara and Stewart, Simon. (2018). Multimorbidity and the risk of all-cause 30-day readmission in the setting of multidisciplinary management of chronic heart failure: A retrospective analysis of 830 hospitalized patients in Australia. Journal of Cardiovascular Nursing. 33(5), pp. 437 - 445. https://doi.org/10.1097/JCN.0000000000000391
Authors | Wiley, Joshua F., Chan, Yih-Kai, Ahamed, Yasmin, Ball, Jocasta, Carrington, Melinda J., Reigel, Barbara and Stewart, Simon |
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Abstract | 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. |
Keywords | chronic heart failure; disease management; multimorbidity; premature readmission |
Year | 2018 |
Journal | Journal of Cardiovascular Nursing |
Journal citation | 33 (5), pp. 437 - 445 |
Publisher | Lippincott Williams & Wilkins |
ISSN | 0889-4655 |
Digital Object Identifier (DOI) | https://doi.org/10.1097/JCN.0000000000000391 |
Scopus EID | 2-s2.0-85009953620 |
Open access | Open access |
Page range | 437 - 445 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | License |
Grant ID | nhmrc/418967 |
nhmrc/1049133 | |
Place of publication | United States of America |
Editors | B. Riegel and D. K. Moser |
https://acuresearchbank.acu.edu.au/item/85v2y/multimorbidity-and-the-risk-of-all-cause-30-day-readmission-in-the-setting-of-multidisciplinary-management-of-chronic-heart-failure-a-retrospective-analysis-of-830-hospitalized-patients-in-australia
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