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  • Title: Hospital readmission in patients with implantable cardioverter-defibrillators.
    Author: Kaźmierczak J, Zielonka J, Rzeuski R, Peregud-Pogorzelska M, Goracy J, Biernawska J, Sulikowski T, Kornacewicz-Jach Z.
    Journal: Kardiol Pol; 2006 Jul; 64(7):684-91; discussion 692-3. PubMed ID: 16886125.
    Abstract:
    INTRODUCTION: Hospital readmissions are one of the important problems of patients with implantable cardioverter-defibrillators (ICD). Detailed analysis of the causes of re-hospitalizations may lead to improved management of ICD patients and eventually limit the number of hospital readmissions. AIM: Prospective analysis of repeat hospitalisations, their causes and time from discharge to first hospital readmission in a group of patients after ICD implantation. A search for predictors of rehospitalisation was also performed. METHODS: Analysis involved 133 consecutive patients who underwent ICD implantation in the Department of Cardiology, PAM. Readmission causes were split into cardiac and non-cardiac. An index of repeat hospitalisation was calculated and parameters with a direct impact on rehospitalisation necessity were also evaluated. RESULTS: One hundred and sixty-seven hospital readmissions of 72 (54%) patients were noted at mean 22+/-15 months after the primary hospitalisation. Rehospitalisation index per patient for the total follow-up period was 1.26, while for the first year of follow-up it was 0.69. In the case of 42 (32%) patients, 91 (54.5%) hospital readmissions were associated with arrhythmia. In 34 (25.6%) patients, 54 (32.3%) re-hospitalizations were not related to arrhythmia, while 20 (15%) patients were hospitalised 22 times (13.2%) for non-cardiac reasons. Mean time to the first readmission, regardless of the reason, was 9+/-9 months. Predominant causes of repeat hospitalisation were ventricular arrhythmias and worsening of heart failure. Patients with left ventricular ejection fraction (LVEF) below 30% and in functional NYHA class III were readmitted to hospital more frequently for reasons not related to arrhythmia. CONCLUSIONS: Hospital readmissions for cardiac causes in patients after ICD implantation are still frequent. Most of them are caused by ventricular arrhythmia and heart failure. Low LVEF (<30%) and NYHA functional class > or =III are risk factors predicting repeat hospitalisations unrelated to arrhythmia.
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