Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/94565
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Type: | Journal article |
Title: | Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study |
Author: | Ranasinghe, I. Wang, Y. Dharmarajan, K. Hsieh, A. Bernheim, S. Krumholz, H. |
Citation: | PLoS Medicine, 2014; 11(9):e1001737-1-e1001737-18 |
Publisher: | Public Library of Science |
Issue Date: | 2014 |
ISSN: | 1549-1277 1549-1676 |
Editor: | Daniels, K. |
Statement of Responsibility: | Isuru Ranasinghe, Yongfei Wang, Kumar Dharmarajan, Angela F. Hsieh, Susannah M. Bernheim, Harlan M. Krumholz |
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. |
Keywords: | Pneumonia Myocardial Infarction Patient Readmission Retrospective Studies |
Rights: | © 2014 Ranasinghe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
DOI: | 10.1371/journal.pmed.1001737 |
Published version: | http://dx.doi.org/10.1371/journal.pmed.1001737 |
Appears in Collections: | Aurora harvest 7 Medicine publications |
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hdl_94565.pdf | Published version | 1.11 MB | Adobe PDF | View/Open |
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