Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

Britt Borregaard; Jordi Sanchez Dahl; Lars Peter Schødt Riber; Ola Ekholm; Kirstine Lærum Sibilitz; Marc Weiss; Jan Sørensen; Selina Kikkenborg Berg; Jacob Eifer Møller

doi:10.1016/j.ijcard.2019.02.056

Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

Britt Borregaard^*, Jordi Sanchez Dahl, Lars Peter Schødt Riber, Ola Ekholm, Kirstine Lærum Sibilitz, Marc Weiss, Jan Sørensen, Selina Kikkenborg Berg, Jacob Eifer Møller

^*Corresponding author for this work

Department of Clinical Medicine

8 Citations (Scopus)

Abstract

Background: Unplanned readmissions after heart valve surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open heart valve surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. Methods: The study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after heart valve surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention)and n = 580 (controls). Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. Results: After 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P < 0.001). The effect did not change in the propensity matched population (HR 0.57; 95% CI 0.43;0.75, P < 0.001). The difference was related to reduction in readmission rates, whereas death rates were similar in intervention and control group (1.6% vs. 1.8%). Conclusion: An intervention consisting of early, individualised and intensified follow-up after open heart valve surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.

Original language	English
Journal	International Journal of Cardiology
Volume	289
Pages (from-to)	30-36
Number of pages	7
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2019.02.056
Publication status	Published - 2019

Keywords

Heart valve surgery
Heart valves
Intervention
Propensity matched
Readmission

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10.1016/j.ijcard.2019.02.056

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Borregaard, B., Dahl, J. S., Riber, L. P. S., Ekholm, O., Sibilitz, K. L., Weiss, M., Sørensen, J., Berg, S. K., & Møller, J. E. (2019). Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality. International Journal of Cardiology, 289, 30-36. https://doi.org/10.1016/j.ijcard.2019.02.056

Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality. / Borregaard, Britt; Dahl, Jordi Sanchez; Riber, Lars Peter Schødt et al.

In: International Journal of Cardiology, Vol. 289, 2019, p. 30-36.

Research output: Contribution to journal › Journal article › Research › peer-review

Borregaard, B, Dahl, JS, Riber, LPS, Ekholm, O, Sibilitz, KL, Weiss, M, Sørensen, J, Berg, SK & Møller, JE 2019, 'Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality', International Journal of Cardiology, vol. 289, pp. 30-36. https://doi.org/10.1016/j.ijcard.2019.02.056

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title = "Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality",

abstract = "Background: Unplanned readmissions after heart valve surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open heart valve surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. Methods: The study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after heart valve surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention)and n = 580 (controls). Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. Results: After 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P < 0.001). The effect did not change in the propensity matched population (HR 0.57; 95% CI 0.43;0.75, P < 0.001). The difference was related to reduction in readmission rates, whereas death rates were similar in intervention and control group (1.6% vs. 1.8%). Conclusion: An intervention consisting of early, individualised and intensified follow-up after open heart valve surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.",

keywords = "Heart valve surgery, Heart valves, Intervention, Propensity matched, Readmission",

author = "Britt Borregaard and Dahl, {Jordi Sanchez} and Riber, {Lars Peter Sch{\o}dt} and Ola Ekholm and Sibilitz, {Kirstine L{\ae}rum} and Marc Weiss and Jan S{\o}rensen and Berg, {Selina Kikkenborg} and M{\o}ller, {Jacob Eifer}",

year = "2019",

doi = "10.1016/j.ijcard.2019.02.056",

language = "English",

volume = "289",

pages = "30--36",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

AU - Borregaard, Britt

AU - Dahl, Jordi Sanchez

AU - Riber, Lars Peter Schødt

AU - Ekholm, Ola

AU - Sibilitz, Kirstine Lærum

AU - Weiss, Marc

AU - Sørensen, Jan

AU - Berg, Selina Kikkenborg

AU - Møller, Jacob Eifer

PY - 2019

Y1 - 2019

N2 - Background: Unplanned readmissions after heart valve surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open heart valve surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. Methods: The study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after heart valve surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention)and n = 580 (controls). Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. Results: After 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P < 0.001). The effect did not change in the propensity matched population (HR 0.57; 95% CI 0.43;0.75, P < 0.001). The difference was related to reduction in readmission rates, whereas death rates were similar in intervention and control group (1.6% vs. 1.8%). Conclusion: An intervention consisting of early, individualised and intensified follow-up after open heart valve surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.

AB - Background: Unplanned readmissions after heart valve surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open heart valve surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. Methods: The study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after heart valve surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention)and n = 580 (controls). Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. Results: After 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P < 0.001). The effect did not change in the propensity matched population (HR 0.57; 95% CI 0.43;0.75, P < 0.001). The difference was related to reduction in readmission rates, whereas death rates were similar in intervention and control group (1.6% vs. 1.8%). Conclusion: An intervention consisting of early, individualised and intensified follow-up after open heart valve surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.

KW - Heart valve surgery

KW - Heart valves

KW - Intervention

KW - Propensity matched

KW - Readmission

U2 - 10.1016/j.ijcard.2019.02.056

DO - 10.1016/j.ijcard.2019.02.056

M3 - Journal article

C2 - 31006596

AN - SCOPUS:85064324761

SN - 0167-5273

VL - 289

SP - 30

EP - 36

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

Abstract

Keywords

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