Table 3.
Studies of preventable readmissions of cardiovascular-related index admissions and readmissions among adults, United States, 2000-2009
| Citation | Reported readmission type (and explanation if provided) | Index condition* | Readmit condition | Timeframe | Population and Setting | Design and Sample size | Data source(s) | Risk factors/associated factors | Conceptually linked admissions† | Strategy for patient linkage‡ | Used multivariate statistics§ |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ahmed et al [21] | Early | Congestive heart failure primary discharge diagnosis | Congestive heart failure | 180 days | Congestive heart failure patients from VA medical center in TX | Retrospective cohort (198) |
Hospital databases |
Patient Decreasing temperature |
Yes | No | Yes |
| Aujeskey et al [23] | Early | Pulmonary embolism | Any and complications of pulmonary embolism (recurrent venous thrombo-embolism and bleeding) | 30 days | Patients ≥18 years in PA | Retrospective cohort (14,426) |
Pennsylvania Healthcare Cost Containment Council database |
Patient African American (any or venous thromboembolism) Increasing PESI risk class (any cause only) Encounter Medicaid Discharge to home with supplementary care (any cause) Left hospital against medical advice (any cause only) Organizational Hospital teaching status (bleeding only) Non-Pittsburg area |
Yes | Yes | Yes |
| Ferraris et al [46] | Early unplanned | Cardiac surgery | Any condition | 30 days | Cardiac patients from single WV medical center | Prospective cohort (2,650) |
Hospital database, Interviews |
Patient Female Diabetes Preoperative atrial fibrillation COPD Renal dysfunction Environment Residential zip code |
No | Yes | Yes|| |
| García et al [25] | Potentially avoidable | Acute myocardial infarction | Acute myocardial infarction - related admissions | 56 days to 3 years | Coronary artery disease in CA | Retrospective cohort (683) |
California Hospital Outcomes Validation Project dataset |
Patient AMI history Encounter Medicaid Less likely with CABG on admission |
Yes | Yes | Yes |
| Hallerbach et al [50] | Early | Congestive heart failure | Congestive heart failure exacerbation admission | 30 days | Congestive heart failure patients from single PA hospital | Case control (58) |
Chart review | No statistically significant factors reported | Yes | No | No |
| Hannan et al [27] | Early | Coronary artery bypass graft | Likely to be complications of Coronary artery bypass graft surgery | 30 days | Coronary artery bypass graft surgery patients in NY | Retrospective cohort (16,325) |
New York State's Cardiac Surgery Reporting System linked with the Statewide Planning and Research Cooperative System |
Patient Increasing age Women Body surface area Myocardial infarction 7 days prior Femoral disease Congestive heart failure Chronic obstructive pulmonary disease Diabetes Hepatic failure Dialysis Encounter Low annual surgeon volume Discharge to skilled nursing or rehabilitation facility Increasing length of stay Organizational High hospital risk adjusted mortality rate |
Yes | Yes | Yes|| |
| Harjai, Nunez et al [28] | Early | Heart failure | Heart failure | 30 days | Heart failure patients from single LA hospital | Retrospective cohort (576) |
Hospital databases, Chart review |
Encounter Treatment with angiotensin-converting enzyme and aspirin |
Yes | No | Yes |
| Harjai, Thompson et al [29] | Early | Heart failure and shock | Any condition or heart failure | 30 days | Heart failure and shock patients from single LA hospital | Retrospective cohort (434) |
Hospital databases |
Patient COPD (any cause and HF) No. of hospitalizations in prior 6 months (any cause and HF) Male (HF only) Increasing blood urea nitrogen (any cause only) |
Yes | No | Yes |
| Howie-Esquivel and Dracup [47] | Early | Acutely decompensated heart failure | Primary diagnosis of heart failure or other cardiac cause | 90 days | Heart failure patients from single CA academic medical center | Prospective cohort (44) |
Chart review |
Patient Female Encounter Increasing length of stay |
Yes | Yes | Yes |
| Keenan et al [32] | Readmissions to the hospital shortly after discharge | Heart failure | Any condition | 30 days | Fee for service Medicare Parts A and B nationwide | Retrospective cohort (1,129,210) |
Medicare inpatient, outpatient, and carrier Standard Analytic Files, Medicare Enrollment Database, National Heart Failure Project database |
Patient History of coronary artery bypass graft surgery less likely Congestive heart failure Acute coronary syndrome Arrhythmias Cardiorespiratory failure and shock Valvular and rheumatic heart disease Vascular or circulatory disease Chronic atherosclerosis Other heart disease Paralysis Stroke Renal failure COPD Diabetes Fluid disorders Urinary tract infections Gastrointestinal disorders Severe hematologic disorder Nephritis Cancer Liver disease Asthma Pneumonia Drug/alcohol abuse or psychosis Fibrosis of the lung Protein-calorie malnutrition (validation dataset not reported) |
No | Yes | Yes |
| Kumbhani et al [34] | Unplanned | Cardiac surgery | Related to complications of cardiac surgery | 30 days and 6 months |
Underwent intra- operative online monitoring of myocardial tissue pH at VA medical center in MA | Retrospective cohort (221) |
Hospital databases |
Patient Low pH at end of bypass Postoperative atrial fibrillation High ASA class Preoperative ejection fraction Encounter Length of stay less than 6 days Myocardial tissue pH < 6.85 at the end of bypass |
Yes | Yes | Yes |
| Lagoe et al [35] | Non-elective and unplanned | Congestive heart failure | Same DRG as index admission | 30 days | Congestive heart failure patients from multiple sites in Syracuse | Retrospective cohort (Not reported) |
New York Statewide Planning and Research Cooperative System |
Organizational Rates varied by hospital |
Yes | Yes | No |
| Sun et al [48] | Early | CABG surgery | Any condition | 30 days | Low risk CABG patients from Single DC hospital | Prospective cohort (2,157) |
Hospital databases, Interviews |
Patient Diabetes |
No | Yes | Yes |
* All exclusion criteria or specific diagnostic codes not reported - see original article for additional details.
† Explicitly specified a biological, theoretical or conceptual model linking the readmission condition to the index condition (includes readmissions for same condition)
‡ Specified a strategy or research design to guard against loss to follow up
§ Used multivariate statistics
||Modeling technique did not account of non-independence of observations in analysis