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Heart, Lung and Circulation

Thirty-Day Unplanned Readmissions Following Hospitalisation for Atrial Fibrillation in Australia and New Zealand

Published:March 10, 2022DOI:https://doi.org/10.1016/j.hlc.2022.02.006

      Aims

      Atrial fibrillation (AF) is a leading cause of hospitalisations, yet little is known about 30-day readmissions following discharge despite increasing policy focus on reducing readmissions. We assessed the rate, timing, causes and predictors of 30-day unplanned readmission following an acute and elective AF hospitalisation using population-wide data.

      Methods

      We studied all patients hospitalised for AF from 2010 to 2015 at all public and most private hospitals in Australia and New Zealand. The main outcome measures were unplanned readmissions within 30 days of discharge, primary diagnosis associated with these readmissions, and their predictors as modelled by logistic regression.

      Results

      Among 301,654 patients hospitalised for AF (mean age 69.2±13.6 yrs, 55.6% female, 65.2% acute presentations), 29,750 (9.9%) experienced an unplanned readmission within 30 days with 62.6% occurring by 14 days. Unplanned readmissions occurred more frequently following an acute versus elective AF hospitalisations (12.5% vs 4.9%, p<0.001). The most common diagnoses associated with readmissions were recurrence of AF (n=9,890, 33.2%), and preventable conditions including heart failure (n=2,683, 9.0%), pneumonia (n=724, 2.4%) and acute myocardial infarction (n=510, 1.7%). A higher risk of 30-day readmission was associated with congenital cardiac/circulatory defect (OR 2.18, CI 1.44–3.30), congestive heart failure (OR 1.34, CI 1.30–1.39), and arrhythmia/conduction disorders (OR 1.25, CI 1.21–1.28).

      Conclusion

      Almost 1 in 10 AF hospitalisations resulted in unplanned readmission within 30-days, mostly for AF recurrence. Improved clinical management of AF and transitional care planning are required to reduce unplanned readmissions following AF hospitalisations.

      Keywords

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      Linked Article

      • A Call to Action to Reduce Preventable Hospitalisations and Health Care Burden Due to Atrial Fibrillation
        Heart, Lung and CirculationVol. 31Issue 7
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          In line with the growing burden of modifiable cardiovascular risk factors in both developed and developing countries, the prevalence of atrial fibrillation (AF) has increased exponentially, with this upward trajectory likely to continue in coming decades [1]. Indeed, there is a growing body of evidence that modifiable risk factors such as obesity, hypertension, physical inactivity, obstructive sleep apnoea, diabetes mellitus and excessive alcohol consumption contribute to the development of the AF substrate, leading to AF progression and recurrence; while targeting these risk factors has been shown to improve sinus rhythm maintenance with reverse atrial remodelling [2–4].
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