In-Hospital Adverse Events in Heart Failure Patients: Incidence and Association with 90-Day Mortality

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2025-03-27 DOI:10.1016/j.jcjq.2025.03.003

Mohammed Yousufuddin MD, MSc (is Critical Care Physician and Hospitalist, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota), Mohamad H. Yamani MD (is Cardiologist, Department of Cardiovascular Medicine, Circulatory Failure, Mayo Clinic, Jacksonville, Florida), Daniel DeSimone MD (is Infectious Disease Specialist and Internist, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota), Ebrahim Barkoudah MD, MPH, MBA (is System Chief of Hospital Medicine and Regional Chief Medical Officer and Chief Quality Officer, Baystate Health, Springfield, Massachusetts), Muhammad Waqas Tahir MD (is Internist, Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida), Zeliang Ma MD, PhD (is Visiting Research Fellow, Department of Hospital Internal Medicine, Mayo Clinic Health System), Fatmaelzahraa Badr MBBCh (is Research Fellow, Department of Hospital Internal Medicine, Mayo Clinic Health System), Ibrahim A. Gomaa MD (is Research Fellow, Department of Hospital Internal Medicine, Mayo Clinic Health System), Sara Aboelmaaty MD (is Research Fellow, Department of Hospital Internal Medicine, Mayo Clinic Health System), Sumit Bhagra MD (is Chair of Endocrinology, Division of Endocrinology and Metabolism, Mayo Clinic Health System), Gregg C. Fonarow MD (is Professor of Clinical Medicine, Division of Cardiology, University of California, Los Angeles), Mohammad H. Murad MD, MPH (is Internist and General Preventive Medicine Specialist, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota. Please address correspondence to Mohammed Yousufuddin)

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引用次数: 0

Abstract

Background

In-hospital adverse events (IHAEs) are key patient safety indicators but are not comprehensively assessed among patients hospitalized for heart failure (HF). The authors aimed to determine the association of IHAEs with downstream outcomes.

Methods

This retrospective multicenter cohort study analyzed data from patients hospitalized for HF in 17 acute care hospitals (2010–2023). The research team abstracted 36 IHAEs and grouped them into eight composite categories. The primary outcome was 90-day all-cause mortality, and secondary outcomes included length of stay (LOS), in-hospital mortality, and 90-day postdischarge all-cause readmission.

Results

Of the 11,169 hospitalized HF patients (median age 77.7 years; 47.0% women; 7.1% non-white; 39.8% from rural counties; 78,869 hospital bed-days), IHAEs occurred at varying frequency across the composite IHAE categories: general 4.6%, cardiovascular 6.6%, pulmonary 11.7%, endocrine and metabolism 9.2%, renal and electrolyte 9.1%, gastrointestinal 4.0%, neurological 2.7%, and hospital-acquired infection (HAI) 3.2%. Except for the renal and electrolyte (hazard ratio [HR] 0.92, p = 0.2956), IHAE in any other category was consistently associated with higher 90-day mortality (HRs 1.50-2.42, p < 0.0001 for all). Associations with secondary outcomes varied by IHAE categories: LOS increased in the general (incident rate ratio [IRR] 1.09), pulmonary (IRR 1.65), neurological (IRR 1.37), and HAI (IRR 1.09) categories (p < 0.0001). In-hospital mortality was higher in all categories except gastrointestinal. The 90-day readmission rate was elevated in the gastrointestinal (HR 1.85), neurological (HR 1.89), and HAI (HR 1.66) categories (p < 0.0001). Guideline-focused medical treatment (GFMT) was associated with reduced mortality in patients with and without IHAEs.

Conclusion

HF cohorts with specific composite IHAEs experience higher in-hospital and 90-day all-cause mortality and increased health care resource utilization. This elevated mortality risk may be mitigated by GFMT, with potential tailoring to each specific IHAE category.

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心衰患者的院内不良事件：发病率及其与90天死亡率的关系

背景：住院不良事件（IHAEs）是关键的患者安全指标，但在心力衰竭（HF）住院患者中尚未得到全面评估。作者旨在确定IHAEs与下游预后的关系。方法：本回顾性多中心队列研究分析了2010-2023年17家急症医院因心衰住院患者的资料。研究小组提取了36个IHAEs，并将它们分为8个复合类别。主要终点为90天全因死亡率，次要终点包括住院时间（LOS）、住院死亡率和出院后90天全因再入院。结果：11169例住院HF患者(中位年龄77.7岁；47.0%的女性;7.1%的白人;农村县占39.8%；78,869医院床位日)，IHAEs在复合IHAEs类别中发生的频率不同：一般4.6%，心血管6.6%，肺部11.7%，内分泌和代谢9.2%，肾脏和电解质9.1%，胃肠道4.0%，神经系统2.7%，医院获得性感染（HAI） 3.2%。除了肾脏和电解质（危险比[HR] 0.92, p = 0.2956）外，任何其他类型的IHAE均与较高的90天死亡率相关（危险比1.50-2.42,p < 0.0001）。与次要结局的关联因IHAE类型而异：LOS在一般（发生率比[IRR] 1.09）、肺（IRR 1.65）、神经（IRR 1.37）和HAI （IRR 1.09）类别中增加（p < 0.0001）。除胃肠道外，所有类别的住院死亡率均较高。胃肠道（HR 1.85）、神经系统（HR 1.89）和HAI （HR 1.66）类别的90天再入院率均升高（p < 0.0001）。以指南为重点的药物治疗（GFMT）与伴有和不伴有IHAEs的患者死亡率降低相关。结论：具有特定复合IHAEs的心衰队列具有更高的住院死亡率和90天全因死亡率，并增加了医疗资源利用率。这种升高的死亡风险可以通过GFMT减轻，并可能针对每个特定的IHAE类别进行定制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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