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Abstract：
OBJECTIVE: Heart failure is a significant disease, and its high readmission rate is a big concern. We must identify readmission risk factors and optimize outpatient management to prevent them. This study aims to investigate the readmission risk factors, including outpatient management represented by the number of outpatient visits, and to identify the factors related to frequent outpatient visits.
RESULTS: We used the diagnosis-procedure-combination database between April 2016 and March 2022. Based on the number of outpatient visits within 60 days after discharge, we categorized patients into <1 visits/month, (1<, ≦2) visits/month, and <2 visits/month and observed the occurrence of 60 days readmission. We performed multiple logistic regression analyses to reveal the readmission risk factors and the association between the number of outpatient visits and readmission. As a subgroup analysis, we conducted the same research in the low- and high-readmission risk groups. We compared medical contents between (1<, ≦2) visits/month and <2 visits/month. We analysed 101 239 patients and identified the following factors as a risk of readmission: older age (P < 0.001), female (P = 0.009), longer length-of-hospital-stay (P < 0.001), artificial ventilator (P < 0.001), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P = 0.036), bottom 50% dosage of class III antiarrhythmic agents (P < 0.001), hypertension (P = 0.005), atrial fibrillation (P < 0.001), dilated cardiomyopathy (P < 0.001), valvular disease (P = 0.021), myocardial infarction (P < 0.001), diabetes (P < 0.001), and renal disease (P < 0.001). We revealed that the risk of readmission increases in <2 visits/month compared to (1<, ≦2) visits/month (P < 0.001), whereas the risk of readmission decreases in ≦1 visits/month compared with (1<, ≦2) visits/month (P < 0.001). In the subgroup analysis, we found the possibility that some risk factors are specific to the subgroup. We identified that the following factors were related to frequent outpatient visits: older age (P < 0.001), home medical care (P = 0.007), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P < 0.001), diabetes (P < 0.001), renal disease (P = 0.009), 0-2 weeks follow-up (P < 0.001), 2-4 weeks follow-up (P < 0.001), cardiac rehabilitation (P < 0.001), and echocardiography (P < 0.001).
CONCLUSIONS: This study comprehensively identified risk factors for readmission and found outpatient visit is personalized by readmission risk. There is still room to optimize outpatient management. We suggest optimizing outpatient management according to our identified characteristics.
RESULTS: We used the diagnosis-procedure-combination database between April 2016 and March 2022. Based on the number of outpatient visits within 60 days after discharge, we categorized patients into <1 visits/month, (1<, ≦2) visits/month, and <2 visits/month and observed the occurrence of 60 days readmission. We performed multiple logistic regression analyses to reveal the readmission risk factors and the association between the number of outpatient visits and readmission. As a subgroup analysis, we conducted the same research in the low- and high-readmission risk groups. We compared medical contents between (1<, ≦2) visits/month and <2 visits/month. We analysed 101 239 patients and identified the following factors as a risk of readmission: older age (P < 0.001), female (P = 0.009), longer length-of-hospital-stay (P < 0.001), artificial ventilator (P < 0.001), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P = 0.036), bottom 50% dosage of class III antiarrhythmic agents (P < 0.001), hypertension (P = 0.005), atrial fibrillation (P < 0.001), dilated cardiomyopathy (P < 0.001), valvular disease (P = 0.021), myocardial infarction (P < 0.001), diabetes (P < 0.001), and renal disease (P < 0.001). We revealed that the risk of readmission increases in <2 visits/month compared to (1<, ≦2) visits/month (P < 0.001), whereas the risk of readmission decreases in ≦1 visits/month compared with (1<, ≦2) visits/month (P < 0.001). In the subgroup analysis, we found the possibility that some risk factors are specific to the subgroup. We identified that the following factors were related to frequent outpatient visits: older age (P < 0.001), home medical care (P = 0.007), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P < 0.001), diabetes (P < 0.001), renal disease (P = 0.009), 0-2 weeks follow-up (P < 0.001), 2-4 weeks follow-up (P < 0.001), cardiac rehabilitation (P < 0.001), and echocardiography (P < 0.001).
CONCLUSIONS: This study comprehensively identified risk factors for readmission and found outpatient visit is personalized by readmission risk. There is still room to optimize outpatient management. We suggest optimizing outpatient management according to our identified characteristics.
摘要：
目的：心力衰竭是一种重要的疾病，它的高再入院率是一个大问题。我们必须识别再入院的危险因素，并优化门诊管理以预防它们。本研究旨在调查再入院的危险因素，包括以门诊就诊次数为代表的门诊管理，并确定频繁门诊就诊的相关因素。
结果：我们在2016年4月至2022年3月之间使用了诊断-程序-组合数据库。根据出院后60天内的门诊量,我们将患者分为<1次/月，(1<,≤2)访问/月，和<2次/月访问，并观察60天再入院的发生。我们进行了多元逻辑回归分析，以揭示再入院的危险因素以及门诊就诊次数与再入院之间的关系。作为子群分析，我们在低和高再入院风险组进行了同样的研究.我们比较了(1<，≤2)访问/月和<2访问/月。我们分析了101.239例患者，确定了以下因素是再入院的风险：年龄较大（P<0.001），女性（P=0.009），住院时间更长（P<0.001），人工呼吸机（P<0.001），托伐普坦（P<0.001），loop利尿剂的前50％剂量（P=0.036），III类抗心律失常药的最低50%剂量（P<0.001），高血压（P=0.005），心房颤动（P<0.001），扩张型心肌病（P<0.001），瓣膜疾病（P=0.021），心肌梗死（P<0.001），糖尿病（P<0.001），和肾脏疾病（P<0.001）。我们发现，与（1<，≤2)访视/月(P<0.001)，而与(1<，≤2)访视/月(P<0.001)。在亚组分析中，我们发现某些危险因素可能是亚组特有的.我们发现以下因素与频繁的门诊就诊有关：年龄较大（P<0.001），家庭医疗（P=0.007），托伐普坦（P<0.001），loop利尿剂的前50％剂量（P<0.001），糖尿病（P<0.001），肾脏疾病（P=0.009），0-2周随访(P<0.001),随访2～4周(P<0.001),心脏康复（P<0.001），超声心动图(P<0.001)。
结论：这项研究全面确定了再入院的危险因素，并发现门诊就诊按再入院风险进行个性化。优化门诊管理仍有空间。我们建议根据我们确定的特点优化门诊管理。
结果：我们在2016年4月至2022年3月之间使用了诊断-程序-组合数据库。根据出院后60天内的门诊量,我们将患者分为<1次/月，(1<,≤2)访问/月，和<2次/月访问，并观察60天再入院的发生。我们进行了多元逻辑回归分析，以揭示再入院的危险因素以及门诊就诊次数与再入院之间的关系。作为子群分析，我们在低和高再入院风险组进行了同样的研究.我们比较了(1<，≤2)访问/月和<2访问/月。我们分析了101.239例患者，确定了以下因素是再入院的风险：年龄较大（P<0.001），女性（P=0.009），住院时间更长（P<0.001），人工呼吸机（P<0.001），托伐普坦（P<0.001），loop利尿剂的前50％剂量（P=0.036），III类抗心律失常药的最低50%剂量（P<0.001），高血压（P=0.005），心房颤动（P<0.001），扩张型心肌病（P<0.001），瓣膜疾病（P=0.021），心肌梗死（P<0.001），糖尿病（P<0.001），和肾脏疾病（P<0.001）。我们发现，与（1<，≤2)访视/月(P<0.001)，而与(1<，≤2)访视/月(P<0.001)。在亚组分析中，我们发现某些危险因素可能是亚组特有的.我们发现以下因素与频繁的门诊就诊有关：年龄较大（P<0.001），家庭医疗（P=0.007），托伐普坦（P<0.001），loop利尿剂的前50％剂量（P<0.001），糖尿病（P<0.001），肾脏疾病（P=0.009），0-2周随访(P<0.001),随访2～4周(P<0.001),心脏康复（P<0.001），超声心动图(P<0.001)。
结论：这项研究全面确定了再入院的危险因素，并发现门诊就诊按再入院风险进行个性化。优化门诊管理仍有空间。我们建议根据我们确定的特点优化门诊管理。
