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RESUMO - Contexto: Estima-se que 25% dos doentes com insuficiência cardíaca (IC) são readmitidos nos primeiros 30 dias após a alta hospitalar, verificando-se que para certos estadios da doença, o risco de readmissão está associado a fatores potencialmente modificáveis. O presente trabalho teve como objetivo conhecer a distribuição temporal das readmissões hospitalares nos primeiros 30 dias após internamento inicial por IC no ano de 2014, identificando os principais fatores associados ao risco de readmissão ao longo desse período de observação.
Metodologia: Foi utilizada a base de dados de morbilidade hospitalar da ACSS de 2014, na qual constam todos os episódios de internamento dos hospitais públicos portugueses do Continente. Foram incluídos os episódios de internamento de adultos (18 ou mais anos) com diagnóstico principal de IC (códigos ICD-9-CM: 428.X). A idade, o sexo, o Índice de Comorbilidades de Charlson (ICC), o número de diagnósticos secundários, o tipo de admissão, o tipo de GDH, a duração do internamento, a demência, a diabetes, a doença cerebrovascular, a DPOC, a doença renal, a doença vascular periférica e o enfarte do miocárdio, foram considerados fatores associados ao risco de readmissão. Para estimar a probabilidade de ocorrência de readmissão nos primeiros 30 dias após internamento inicial por IC, foi utilizado o método de Kaplan-Meier (KM). Na análise dos fatores que influenciam o tempo até à readmissão, foi utilizado o modelo de regressão de Cox. Através deste modelo foram estimados os hazard ratio que permitiram avaliar o efeito das variáveis explicativas no tempo de readmissão.
Resultados: Dos 13 857 episódios de internamento, foram registadas 1 861 readmissões nos primeiros 30 dias após internamento inicial por IC, o que corresponde a uma taxa de incidência de 13,4%. Verificou-se um maior risco de readmissão no grupo de doentes admitidos de forma urgente, com doença vascular periférica, com idade avançada (85+ anos), com doença renal e com 9+ diagnósticos secundários. Apenas o ICC, a doença renal e a demência, tiveram influência no tempo médio até à ocorrência de readmissão nos primeiros 6 dias após a alta hospitalar.
Conclusão: As readmissões nos doentes com IC são frequentes e influenciadas por múltiplos fatores. A avaliação do perfil económico e psicossocial de um doente com IC, independentemente do clínico, pode ser útil na prevenção e redução das readmissões, permitindo um melhor direcionamento e planeamento de recursos para intervenções adequadas, melhorando a qualidade e a eficiência dos cuidados prestados.
ABSTRACT - Context: It is estimated that 25% of patients with heart failure (HF) are readmitted within the first 30 days after hospital discharge. For some stages of the disease the risk of readmission is associated with potentially variable factors. This study aims to analyse the temporal distribution of hospital readmissions within the first 30 days after initial hospitalisation for heart failure in 2014. Furtherman it identifies the main factors associated with the risk of readmission during this observation period. Methodology: For the purposes of this study, ACSS hospital morbidity database was used. It includes all episodes of hospitalisation in portuguese public hospitals on the mainland. Hospitalisation episodes of adults (18 years or older) with a main diagnosis of heart failure (HF) were included, based on the ICD-9-CM, through codes 428.X. The Kaplan-Meier (KM) method was used to estimate the probability of readmission occurring within the first 30 days after initial hospitalization for HF. The Cox regression model was used to analyse the factors influencing time to readmission. This last model, allowed the evaluation on the effect of the explanatory variables at the time of readmission, due to the estimation of the hazard ratios. Results: For the 13 857 hospitalization episodes, 1861 readmissions were recorded in the first 30 days after initial hospitalization for HF, corresponding to a cumulative incidence rate of 13,4%. There was an increased risk of readmission in the group of patients admitted urgently, with peripheral vascular disease, patients over 85 years old, with renal disease and with more than 9 secondary diagnoses. The variables COPD, duration of hospitalization, sex and myocardial infarction, did not have an effect on readmission time. Only ICC, renal disease and dementia had impact on the average time to readmission within the first 6 days after discharge. Conclusion: Readmissions in HF patients are frequent and influenced by multiple factors. The assessment of the economic and psychosocial profile of a patient with HF can be useful to prevent and reduce readmissions. It allows a better targeting and resources planning for appropriate interventions, improving the quality and efficiency of the medical care provided.
ABSTRACT - Context: It is estimated that 25% of patients with heart failure (HF) are readmitted within the first 30 days after hospital discharge. For some stages of the disease the risk of readmission is associated with potentially variable factors. This study aims to analyse the temporal distribution of hospital readmissions within the first 30 days after initial hospitalisation for heart failure in 2014. Furtherman it identifies the main factors associated with the risk of readmission during this observation period. Methodology: For the purposes of this study, ACSS hospital morbidity database was used. It includes all episodes of hospitalisation in portuguese public hospitals on the mainland. Hospitalisation episodes of adults (18 years or older) with a main diagnosis of heart failure (HF) were included, based on the ICD-9-CM, through codes 428.X. The Kaplan-Meier (KM) method was used to estimate the probability of readmission occurring within the first 30 days after initial hospitalization for HF. The Cox regression model was used to analyse the factors influencing time to readmission. This last model, allowed the evaluation on the effect of the explanatory variables at the time of readmission, due to the estimation of the hazard ratios. Results: For the 13 857 hospitalization episodes, 1861 readmissions were recorded in the first 30 days after initial hospitalization for HF, corresponding to a cumulative incidence rate of 13,4%. There was an increased risk of readmission in the group of patients admitted urgently, with peripheral vascular disease, patients over 85 years old, with renal disease and with more than 9 secondary diagnoses. The variables COPD, duration of hospitalization, sex and myocardial infarction, did not have an effect on readmission time. Only ICC, renal disease and dementia had impact on the average time to readmission within the first 6 days after discharge. Conclusion: Readmissions in HF patients are frequent and influenced by multiple factors. The assessment of the economic and psychosocial profile of a patient with HF can be useful to prevent and reduce readmissions. It allows a better targeting and resources planning for appropriate interventions, improving the quality and efficiency of the medical care provided.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
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Universidade Nova de Lisboa. Escola Nacional de Saúde Pública