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In-Hospital Mortality and Hospital Readmissions in Parturients with Cardiovascular Disease: A National Readmissions Database Study
Abstract Number: F-14
Abstract Type: Original Research
Cardiovascular disease (CVD) is the leading cause of mortality among parturients in the U.S.1. Potential causes for this include: women with congenital heart disease living longer, advanced maternal age, and a higher prevalence of comorbidities such as obesity, diabetes mellitus and hypertensive diseases of pregnancy. However, the incidence, outcomes and risk factors for readmission in patients with CVD at delivery are poorly characterized. Using a large national database, we examined the mortality rate and risk factors associated with 30-day readmission in parturients with CVD.
A retrospective cohort analysis was done using data from the National Readmission Database (NRD) for 2013-14. The NRD is maintained by the Agency for Healthcare Quality and Research and can be weighted to produce national estimates. Unweighted the NRD contains 14-million discharges for 2013, weighted it is approximately 35-million discharges, accounting for 51.2% of the U.S. population and 49.3 % of all U.S. hospitalizations2. Women admitted for delivery were further identified as having CVD using Clinical Classifications Software (CCS) definitions3 where patient diagnoses are clustered into clinically important categories. We used clustered logistic regression modeling to predict risk factors for readmissions.
Of the 6,983,133 women who delivered during 2013-14, 825,371 (11.82%) had CVD. Overall, in-hospital mortality rate was 18/100,000 compared to 90.3/100,000 in patients with CVD and 8/100,000 in women without CVD. Overall, 30-day readmission in all women was 1.4%, 3.5% in women with CVD, and 1.13% in women without CVD. The mean time between initial discharge and readmission was 8.44 days in patients with CVD. The most common reasons for readmission included: hypertensive disorders (33%) and wound infection (10.9%). Most common risk factors for readmission were trauma, heart failure, venous thromboembolism, and chronic renal disease.
Cardiovascular disease during pregnancy is associated with substantial morbidity and mortality. Readmissions in this patient population are often related to hypertensive disorders and wound infection. Improved management of peripartum hypertension may lead to a decrease in readmissions for these patients.
1. Elkayam; JACC 2016; 4: 396-410