Impact of a Novel Adaptive Optimization Algorithm on 30-Day Readmissions Evidence From the Adaptive CRT Trial
Impact of a Novel Adaptive Optimization Algorithm on 30-Day Readmissions Evidence From the Adaptive CRT Trial
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DOI：
10.1016/j.jchf.2015.03.001
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发表时间：
2015-07-01
影响因子：
13
通讯作者：
Martin, David O.
中科院分区：
文献类型：
--
作者：
Starling, Randall C.;Krum, Henry;Martin, David O.
本研究调查了Medtronic AdaptivCRT（aCRT）的影响（Medtronic，土丘视图，明尼苏达州）算法对心力衰竭（HF）和全因指数住院后30天再入院的影响。当出院后30天内的再入院超过基于全国平均水平和医院特定风险调整的移动阈值时，减少医疗保险住院费用。在国际上，出院后30天内再入院可能会减少或不支付费用。最近，引入了配备有允许自动化流动设备编程的aCRT算法的心脏起搏治疗（CRT）设备。自适应CRT试验证明了该算法的安全性和可比的结果对一个严格的基于超声心动图的优化protocol.METHODS我们分析了数据从自适应CRT试验，随机接受CRT除颤的患者2：1的基础上aCRT（n = 318）或CRT与超声心动图优化（回声，n = 160），并随访这些患者平均20.2个月（范围：0.2至31.3个月）。采用Logistic回归广义估计方程方法比较30天内因HF住院和因各种原因再入院的患者比例。aCRT组为35.7%（17/89），Echo组为35.7%（15/42）（比值比：0.41; 95%置信区间[CI]：0.19 - 0.86; p = 0.02）。对于全因住院，aCRT组的30天再入院率为14.8%（35/237），而Echo组为24.8%（39/157）（比值比：0.54; 95% CI：0.31 - 0.94; p = 0.03）。HF或全因指数住院后再入院与aCRT的风险也显着降低超过30 day.CONCLUSIONS使用的aCRT算法是与一个显着减少30天后再入院的概率HF和全因住院。（适应性心脏复苏治疗研究[aCRT]; NCT 00980057）（C）2015年美国心脏病学会基金会。
OBJECTIVES This study investigated the impact of the Medtronic AdaptivCRT (aCRT) (Medtronic, Mounds View, Minnesota) algorithm on 30-day readmissions after heart failure (HF) and all-cause index hospitalizations.BACKGROUND The U.S. Hospital Readmission Reduction Program, which includes a focus on HF, reduces Medicare inpatient payments when readmissions within 30 days of discharge exceed a moving threshold based on national averages and hospital-specific risk adjustments. Internationally, readmissions within 30 days of any discharge may attract reduced or no payment. Recently, cardiac resynchronization therapy (CRT) devices equipped with the aCRT algorithm allowing automated ambulatory device programming were introduced. The Adaptive CRT trial demonstrated the algorithm's safety and comparable outcome against a rigorous echocardiography-based optimization protocol.METHODS We analyzed data from the Adaptive CRT trial, which randomized patients undergoing CRT defibrillation on a 2:1 basis to aCRT (n = 318) or to CRT with echocardiographic optimization (Echo, n = 160) and followed up these patients for a mean of 20.2 months(range: 0.2 to 31.3 months). Logistic regression with generalized estimating equation methodology was used to compare the proportion of patients hospitalized for HF and for all causes who had a readmission within 30 days.RESULTS For HF hospitalizations, the 30-day readmission rate was 19.1% (17 of 89) in the aCRT group and 35.7% (15 of 42) in the Echo group (odds ratio: 0.41; 95% confidence interval [CI]: 0.19 to 0.86; p = 0.02). For all-cause hospitalization, the 30-day readmission rate was 14.8% (35 of 237) in the aCRT group compared with 24.8% (39 of 157) in the Echo group (odds ratio: 0.54; 95% CI: 0.31 to 0.94; p = 0.03). The risk of readmission after HF or all-cause index hospitalization with aCRT was also significantly reduced beyond 30 days.CONCLUSIONS Use of the aCRT algorithm is associated with a significant reduction in the probability of a 30-day readmission after both HF and all-cause hospitalizations. (Adaptive Cardiac Resynchronization Therapy Study [aCRT]; NCT00980057) (C) 2015 by the American College of Cardiology Foundation.