Yusoff, Mohd Yusran (2024) Time to readmission and its prognostic factors among hospitalised heart failure patients in Kelantan. Masters thesis, Universiti Sains Malaysia.
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Abstract
Heart failure (HF) is a common comorbidity among adult population and is associated with poor outcomes. One challenging aspect of it is the issue of recurrent admissions leading to significant healthcare burden. The aim of this study is to explore the proportion of readmission, median time and prognostic factors for time to readmission among hospitalised HF patients in Kelantan. This retrospective cohort study involved patients admitted primarily for HF in Hospital Raja Perempuan Zainab II from October 2021 until December 2022. Inclusion criteria include adult Malaysian citizen, age 18 years old and above with formal echo finding within one year of index hospitalisation. Those with in-patient mortality, transferred to another facility upon discharge or discharge at own risk and those with active malignancy were excluded. The cohort were followed up until December 2023 to identify the event of readmission which is defined as admission due to acute illness. Patients who had no readmission, loss to follow up or passed away were censored. Sociodemographic characteristics, clinical data during index hospitalisation including laboratory result and medication upon discharge were collected. Data was collected from electronic medical record based on standardised online data proforma and analysis was done using RStudio and StataMP. Prognostic factors for time to readmission were identified using multiple Cox regression analysis. A total of 276 patients were included for analysis. Mean age was 60.64 years old. Most of them were Malays (95.3%) with higher proportion of male (53.6%). Common comorbidities include Hypertension (81.5%), ischaemic heart disease (62%), type II diabetes mellitus (57.2%) and chronic kidney disease (50.4%). Proportion of readmission at 6 Month and 1 year post discharge was 51.8% (95% CI: 45.8, 57.8) and 63.4% (95% CI: 57.4, 69.0) respectively. The cohort had median time to readmission of 118 days (95% CI: 90,149). Prognostic factors for time to readmission were atrial fibrillation (adjusted HR: 2.06, 95% CI: 1.42, 2.99, P<0.001), chronic kidney disease (adjusted HR: 1.53, 95% CI: 1.14, 2.04, P=0.004), albumin level (adjusted HR: 0.96, 95% CI: 0.94, 0.99, P=0.005), aspartate aminotransferase level (adjusted HR: 1.003, 95% CI: 1.001, 1.006, P=0.022) and ejection fraction ≤40% (adjusted HR: 1.37, 95% CI: 1.03, 1.84, P=0.033). In conclusion, HF patients in Kelantan were relatively younger and had a higher rate of readmission compared to global figures at 6-month. Clinicians need to optimise patients prior to discharge with particular attention to the identified prognostic factors.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | heart failure, hospitalization |
| Subjects: | R Medicine R Medicine > RC Internal medicine > RC666-701 Diseases of the circulatory (Cardiovascular) system |
| Divisions: | Kampus Kesihatan (Health Campus) > Pusat Pengajian Sains Perubatan (School of Medical Sciences) > Thesis |
| Depositing User: | Mr Abdul Hadi Mohammad |
| Date Deposited: | 13 Jul 2025 08:12 |
| Last Modified: | 22 Jul 2025 02:20 |
| URI: | http://eprints.usm.my/id/eprint/62601 |
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