Thirty-Day Readmission Rate in Acute Heart Failure Patients Discharged Against Medical Advice in a Matched Cohort Study

Mayo Clinic Proceedings
Brijesh PatelBruce Feldman

Abstract

To determine the readmission rate in patients with acute heart failure (AHF) discharged against medical advice (AMA). We performed a retrospective analysis using the 2014 National Readmission Database. Patients admitted with a primary diagnosis of AHF were selected. Only those discharged to home and who left AMA were included in the study. The primary outcome was 30-day readmission. We compared the readmission rates among those discharged AMA vs routinely discharged patients using propensity score matching (PSM) to address imbalance in variables between the 2 groups. We matched 3 routinely discharged patients to 1 patient who left AMA. We identified 273,489 patients with AHF, of whom 116,869 qualified for further study analysis. A total of 2014 patients (1.7%) were in the AMA group and 114,855 (98.3%) were in the routinely discharged group. After PSM, 6042 routinely discharged patients were matched with 2014 patients from the AMA group. The standard mean difference for each variable was less than 10% postmatching. The 30-day readmission rate among those who left AMA was higher than among those routinely discharged (33% vs 20.1%; P<.001). Heart failure (44.8%) was the most common cause of readmission in the AMA group. Patients w...Continue Reading

Citations

Sep 5, 2018·Clinical Cardiology·Pradhum RamVincent M Figueredo
Nov 7, 2019·Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality·Sri Lekha TummalapalliEric R Goodlev
Mar 7, 2020·Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality·Eberechukwu OnukwughaDavid Alfandre
Nov 25, 2020·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Aakash Bipin GandhiDavid Alfandre
Nov 17, 2021·Journal of Comparative Effectiveness Research·Eberechukwu OnukwughaDavid Alfandre
Mar 17, 2021·Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality·David AlfandreEberechukwu Onukwugha

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