Can a Score Accurately Predict Readmissions in Geriatric Patients with Congestive Heart Failure?

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Journal of the American Geriatrics Society




Background: Congestive heart failure (CHF) affects 5.7 million Americans, It is considered the main cause of readmissions in adult population, associated with 134,500 readmissions annually. The LACE index is a commonly used tool to identify patients at risk of readmission or death within 30 days after hospital discharge. Methods: This is a retrospective study, we analyzed Electronic Medical Records of geriatric patients admitted with discharged diag- nose of acute Congestive Heart Failure decompensation from January 2012 to December 2014; selected patients were followed up for the next 30 days to determine if they were readmitted due acute CHF decompensation. Patients with admission no related to acute decompensation of CHF were excluded. For each patient we collected data regarding age, sex, ethnicity, body mass index, reason for admission, comorbidities (DM, renal/liver disease, etc.). Results: 49 patients were enrolled in the study, with 33 patients readmitted within 30 days and 16 patients with no readmissions within 30 days. We found patients in the readmission group had higher mean age compared with those who were not readmitted (77 years vs 71 years, p-value 0.04). In both groups LACE index was found elevated, when comparing high risk patients vs no high risk patients using LACE index there was no statistically significance (OR 2.13 95%CI 0.12-36.0 p-value 0.6). Length of hospital staying on readmis- sion group was 5.6 days and in no readmission group 4.5 days (P-value 0.23). Emergency department visit on readmission group was 1.4 and in no readmission group 1.1 (P-value 0.46). There was no statistical difference in both groups regarding Gender, ischemic heart disease, systolic heart failure and BMI. Conclusion: In this single retrospective study, LACE index score did not accurately predicted readmission within 30 days in geriatric patients with CHF. Not statistically difference among low risk patient and high risk using LACE index in terms of readmission within 30 days was found. Predicting who will be re-hospitalized is difficult, and much is unexplained.