[Predictive variables of early hospital readmission in cardiac failure]. / Variables predictivas del reingreso hospitalario precoz en la insuficiencia cardíaca.

ABSTRACT

BACKGROUND: Heart failure (HF) is one of the diagnosis leading to a high number of readmissions in our hospitals. There is some controversy about the role played by two groups of variables on the risk or readmissions patient-dependent variables, such as clinical severity, and the characteristics of medical care during the previous admission, in terms of care quality. STUDY POPULATION admissions due to HF with home discharge. DESIGN: case-control study. CASES episodes followed by emergent admission within 30 days because of related diagnosis ("early readmission") (n = 51). CONTROLS random sample of episodes not followed by an early readmission (n = 51). Information collected review of clinical records. Groups of predictive variables studied demographics, clinical severity, clinical parameters prognostic of HF and characteristics of medical care. Bivariate and multivariate statistical analysis: logistic regression (LR). RESULTS: LR analysis detected only one variable predicting early readmission, the ischemic etiology. Odds ratio = 4.78 (95% CI 1.44; 15.88). There were no differences between the study groups regarding age, sex, clinical instability at discharge, hospital stay length, severity (APACHE III and other evaluation methods) and other prognostic parameters of HF (ejection fraction, functional degree, cardiomegaly, concurrent diabetes, valvular disease, atrial fibrillation, hyponatremia, and use of anti-arrhythmic drugs). CONCLUSIONS: The risk for an early readmission is mainly explained by the clinical variables of patients, basically ischemic etiology, and not by the characteristics of medical care clinical instability at discharge or hospital stay length.