The highest risk for readmission and death after pneumonia is in the early days following discharge, but although the risk diminishes after that time, it doesn’t disappear, say researchers from Columbia University in New York City; Yale-New Haven Hospital and Yale University, both in New Haven, Connecticut; and Harvard School of Public Health in Boston, Massachusetts. Findings from their study of > 3 million patients aged ≥ 65 years with heart failure, acute myocardial infarction (AMI), and pneumonia suggest that patients “should remain vigilant for deterioration in health well beyond the first month after hospital discharge.”
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Their study was designed to define trajectories of risk for a full year after hospitalization. Those risks varied according to diagnosis. For instance, for the risk of first readmission to decline 50% for pneumonia took 25 days and for risk of death to decline 50% took 10 days. By contrast, risk of readmission declined 50% by day 38 for heart failure and by day 13 for AMI. The number of days required for the daily change in risk of first readmission to decline 95% from its maximum daily decline was 45 days for pneumonia, 38 for AMI, and 45 for heart failure.
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Daily risks of first readmission and death reached plateaus of minimal day-to-day change by 7 weeks after hospitalization for all 3 conditions. A key finding, the researchers say, is the fact that patients remain at increased risk of acute health events for much longer than the amount of time for which they are at highest risk of death. Depending on the diagnosis, the risk of readmission declined 50% within 13 to 39 days, whereas a similar decline in risk of death required only 6 to 12 days. Such information, the researchers note, can help hospitals better align preventive interventions with the periods of greatest risk.
Source
Dharmarajan K, Hsieh AF, Kulkarni VT, et al. BMJ. 2015;350:h411.
doi: 10.1136/bmj.h411.
