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Predictors of Rehospitalisation after Acute Coronary Syndrome (ACS): Insights from the Australia-New Zealand (ANZ) Population of the Global Registry of Acute Coronary Events (GRACE)
Abstracts
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Predictors of Mortality in Infective Endocarditis in Contemporary Australian Practice Over 13 Years
Predictors of Rehospitalisation after Acute Coronary Syndrome (ACS): Insights from the Australia-New Zealand (ANZ) Population of the Global Registry of Acute Coronary Events (GRACE)
K. Lu 1,∗ , R. Reddy 1 , K. Profitis 1 , L. Kearney 1,2 , B. Wai 1,2 , M. Ord 1,2 , P. Srivastava 1,2 1 Department
of Cardiology, Melbourne University, Austin Health, Melbourne, Australia 2 Department of Medicine, Melbourne University, Austin Health, Melbourne, Australia Background: Infective endocarditis (IE) is a disease associated with high morbidity and mortality. We analysed the prognostic significance of epidemiological, clinical and microbiological factors in adult patients with IE at an Australian tertiary teaching hospital over a 13-year period. Methods: Consecutive patients managed at the Austin hospital between 1996 and 2009 with definite IE by modified Duke criteria were retrospectively enrolled. Baseline clinical, biochemical, microbiological characteristics were analysed. Primary outcome was all cause mortality. Results: One hundred and forty-eight patients were enrolled with a mean follow-up of 3.8 ± 3 years. The median age was 58 ± 17 years, 66% were male, 22% were diabetic, 16% had renal impairment (Cr > 0.12 mmol/L), 14% had pre-existing heart failure (HF), 16% had prosthetic valves and Staphylococcus aureus was the most common pathogen (52%). Vegetations on echocardiography were most frequently found on the mitral valve (36%) and then aortic valve (27%). Surgery was undertaken in 46% of patients. In-hospital and long-term mortality was 24% and 47%, respectively. On logistic regression analyses; new onset heart failure complicating index admission (HR 2.73 [1.54–4.83], p < 0.001), S. aureus infections (HR 1.96 [1.18–3.22], p < 0.01), increasing age (HR 1.05 [1.03–1.07], p < 0.001), and low haemoglobin (Hb < 12 g/dL) (HR 1.02 [1.01–1.03], p < 0.001) were independently associated with increased mortality. However, surgical treatment was protective (HR 0.46 [0.24–0.87], p < 0.02) for mortality. Conclusions: IE remains associated with high-mortality despite improvements in diagnosis and management. New onset heart failure, S. aureus infections and anaemia should alert clinicians to increased risk of adverse events. doi:10.1016/j.hlc.2010.06.541
P. Sangu 1,∗ , I. Ranasinghe 1 , B. Alprandi-Costa 1 , G. Devlin 2 , J. Elliott 3 , J. Lefkovitz 4 , D. Brieger 1 1 Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia 2 Department of Cardiology, Waikato Hospital, Hamilton, New Zeland 3 Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand 4 Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Background: It is unclear if specific patient factors are useful in identifying patients who are at risk for readmission after an ACS. We sought to identify patient factors predictive of readmission. Method: Data were analyzed from 5219 patients with an ACS enrolled in the ANZ population of GRACE) between 1999 and 2007. Patients who had readmission due to cardiovascular diagnosis within 6 months of discharge were identified and compared to those without a readmission. Regression analysis was used to predict independent patient factors associated with readmission. Results: 1048 patients (20.1% mean age 67.7 ± 12.9, 64% male) were readmitted within 6 months with a significant proportion (41.4%) occurring within 1 month of discharge from hospital. Readmission was associated with greater risk of unscheduled cardiac catheterization and 6-month mortality (8.34% vs. 2.45%, p < 0.001). Past history of heart failure (OR 1.52, 95% CI 1.21–1.95), high GRACE risk score at presentation (OR 1.49, 95% CI 1.16–1.91) and recurrent ischemia during admission (OR 1.36, 95% CI 1.17–1.58) were the strongest predictors of increased readmission. Conversely, in hospital prescription of clopidogrel (OR 0.84, 95% CI 0.71–0.99), revascularization by CABG (OR 0.67, 95% CI 0.52–0.86) and more recent enrollment (2005–2007, OR 0.60, 95% CI 0.48–0.73) were the strongest predictors of reduced readmission. Conclusion: Several patient and clinical factors identify patients at higher risk of readmission. Escalating post discharge care in these patients may improve their outcomes. doi:10.1016/j.hlc.2010.06.542
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
S223
529
530
Predictors of Mortality in Infective Endocarditis in Contemporary Australian Practice Over 13 Years
Predictors of Rehospitalisation after Acute Coronary Syndrome (ACS): Insights from the Australia-New Zealand (ANZ) Population of the Global Registry of Acute Coronary Events (GRACE)
K. Lu 1,∗ , R. Reddy 1 , K. Profitis 1 , L. Kearney 1,2 , B. Wai 1,2 , M. Ord 1,2 , P. Srivastava 1,2 1 Department
of Cardiology, Melbourne University, Austin Health, Melbourne, Australia 2 Department of Medicine, Melbourne University, Austin Health, Melbourne, Australia Background: Infective endocarditis (IE) is a disease associated with high morbidity and mortality. We analysed the prognostic significance of epidemiological, clinical and microbiological factors in adult patients with IE at an Australian tertiary teaching hospital over a 13-year period. Methods: Consecutive patients managed at the Austin hospital between 1996 and 2009 with definite IE by modified Duke criteria were retrospectively enrolled. Baseline clinical, biochemical, microbiological characteristics were analysed. Primary outcome was all cause mortality. Results: One hundred and forty-eight patients were enrolled with a mean follow-up of 3.8 ± 3 years. The median age was 58 ± 17 years, 66% were male, 22% were diabetic, 16% had renal impairment (Cr > 0.12 mmol/L), 14% had pre-existing heart failure (HF), 16% had prosthetic valves and Staphylococcus aureus was the most common pathogen (52%). Vegetations on echocardiography were most frequently found on the mitral valve (36%) and then aortic valve (27%). Surgery was undertaken in 46% of patients. In-hospital and long-term mortality was 24% and 47%, respectively. On logistic regression analyses; new onset heart failure complicating index admission (HR 2.73 [1.54–4.83], p < 0.001), S. aureus infections (HR 1.96 [1.18–3.22], p < 0.01), increasing age (HR 1.05 [1.03–1.07], p < 0.001), and low haemoglobin (Hb < 12 g/dL) (HR 1.02 [1.01–1.03], p < 0.001) were independently associated with increased mortality. However, surgical treatment was protective (HR 0.46 [0.24–0.87], p < 0.02) for mortality. Conclusions: IE remains associated with high-mortality despite improvements in diagnosis and management. New onset heart failure, S. aureus infections and anaemia should alert clinicians to increased risk of adverse events. doi:10.1016/j.hlc.2010.06.541
P. Sangu 1,∗ , I. Ranasinghe 1 , B. Alprandi-Costa 1 , G. Devlin 2 , J. Elliott 3 , J. Lefkovitz 4 , D. Brieger 1 1 Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia 2 Department of Cardiology, Waikato Hospital, Hamilton, New Zeland 3 Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand 4 Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Background: It is unclear if specific patient factors are useful in identifying patients who are at risk for readmission after an ACS. We sought to identify patient factors predictive of readmission. Method: Data were analyzed from 5219 patients with an ACS enrolled in the ANZ population of GRACE) between 1999 and 2007. Patients who had readmission due to cardiovascular diagnosis within 6 months of discharge were identified and compared to those without a readmission. Regression analysis was used to predict independent patient factors associated with readmission. Results: 1048 patients (20.1% mean age 67.7 ± 12.9, 64% male) were readmitted within 6 months with a significant proportion (41.4%) occurring within 1 month of discharge from hospital. Readmission was associated with greater risk of unscheduled cardiac catheterization and 6-month mortality (8.34% vs. 2.45%, p < 0.001). Past history of heart failure (OR 1.52, 95% CI 1.21–1.95), high GRACE risk score at presentation (OR 1.49, 95% CI 1.16–1.91) and recurrent ischemia during admission (OR 1.36, 95% CI 1.17–1.58) were the strongest predictors of increased readmission. Conversely, in hospital prescription of clopidogrel (OR 0.84, 95% CI 0.71–0.99), revascularization by CABG (OR 0.67, 95% CI 0.52–0.86) and more recent enrollment (2005–2007, OR 0.60, 95% CI 0.48–0.73) were the strongest predictors of reduced readmission. Conclusion: Several patient and clinical factors identify patients at higher risk of readmission. Escalating post discharge care in these patients may improve their outcomes. doi:10.1016/j.hlc.2010.06.542
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268