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Effect of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Weight on Emergency Hospitalization and 30-Day Mortality in the General Population.

ABSTRACT: Background Variability in blood pressure, glucose concentration, cholesterol concentration, or body weight is associated with a wide range of health outcomes. We hypothesized that high variability in metabolic parameters is associated with an increased risk of emergency hospitalization and mortality. Methods and Results Using a nationally representative database from the Korean National Health Insurance System, 8 049 228 individuals who underwent 3 or more health examinations during 2005 to 2010 were followed up until the end of 2016. Variability in fasting blood glucose and total cholesterol concentrations, systolic blood pressure, and body weight was measured using the variability independent of the mean (VIM). High variability was defined as the highest quartile of variability. Subjects were classified according to the number of high variability parameters. The end points of the study were emergency hospitalization and 30-day mortality. There were 733 387 emergency hospitalizations (9.1%) during a median follow-up of 5.6±1.2 years. For each metabolic parameter, an incrementally higher risk of emergency hospitalization was observed for higher VIM quartile groups than for the lowest quartile group. Compared with the group with low variability for all 4 parameters, the group with high variability for all 4 parameters had a significantly higher risk for emergency hospitalization (hazard ratio [HR], 1.58; 95% CI, 1.54-1.61) and 30-day mortality (HR, 2.44; 95% CI, 1.62-3.69), after adjusting for possible confounding factors. Conclusions High variability in metabolic parameters was associated with increased risk of emergency hospitalization and short-term mortality.

SUBMITTER: Lee SH

PROVIDER: S-EPMC7763740 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Effect of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Weight on Emergency Hospitalization and 30-Day Mortality in the General Population.

Lee Seung-Hwan SH Han Kyungdo K Kwon Hyuk-Sang HS Yoon Kun-Ho KH Kim Mee Kyoung MK

Journal of the American Heart Association 20201106 22

Background Variability in blood pressure, glucose concentration, cholesterol concentration, or body weight is associated with a wide range of health outcomes. We hypothesized that high variability in metabolic parameters is associated with an increased risk of emergency hospitalization and mortality. Methods and Results Using a nationally representative database from the Korean National Health Insurance System, 8 049 228 individuals who underwent 3 or more health examinations during 2005 to 2010 ...[more]

PMID: 33153393

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Project description:ImportanceTrauma of hospitalization refers to the depersonalizing and stressful experience of a hospital admission and is hypothesized to increase the risk of readmission after discharge.ObjectivesTo characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge.Design, setting, and participantsThis prospective cohort study enrolled participants between September 1, 2016, and September 1, 2017, at 2 academic hospitals in Toronto, Canada. Participants were adults admitted to the internal medicine ward for more than 48 hours. Participants were interviewed before discharge using a standardized questionnaire to assess sleep, mobility, nutrition, and mood. Responses for each domain were dichotomized as disturbance or no disturbance. Disturbance in 3 or 4 domains (the upper tertile) was considered high trauma of hospitalization, and disturbance in 0 to 2 domains (the lower 2 tertiles) was considered low trauma.Main outcome and measuresThe primary outcome was readmission or emergency department visit within 30 days of discharge. The association between trauma of hospitalization and the primary outcome was examined using logistic regression, adjusted for age; sex; length of stay; Charlson Comorbidity Index Score; Laboratory-Based Acute Physiology Score; and baseline disturbances in sleep, mobility, nutrition, and mood.ResultsA total of 207 patients participated, of whom 82 (39.6%) were women and 125 (60.4%) were men, with a mean (SD) age of 60.3 (16.8) years. Among the 207 participants, 75 (36.2%) reported sleep disturbance, 162 (78.3%) reported mobility disturbance, 114 (55.1%) reported nutrition disturbance, and 48 (23.2%) reported mood disturbance. Nearly all participants (192 [92.8%]) described a disturbance in at least 1 domain, and 61 participants (29.5%) had high trauma exposure. A statistically significant 15.8% greater absolute risk of readmission or emergency department visit was found in participants with high trauma (37.7%; 95% CI, 25.9%-51.1%) compared with those with low trauma (21.9%; 95% CI, 15.7%-29.7%), which remained statistically significant after adjusting for baseline characteristics (adjusted odds ratio, 2.52; 95% CI, 1.24-5.17; P = .01) and propensity score matching (odds ratio, 2.47; 95% CI, 1.11-5.73; P = .03).Conclusions and relevanceDisturbances in sleep, mobility, nutrition, and mood were common in medical inpatients; such trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after hospital discharge.

Project description:IntroductionNew financial incentives, such as reduced Medicare reimbursements, have led hospitals to closely monitor their readmission rates and initiate efforts aimed at reducing them. In this context, many surgical departments participate in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects detailed demographic, laboratory, clinical, procedure and perioperative occurrence data. The availability of such data enables the development of data science methods which predict readmissions and, as done in this paper, offer specific recommendations aimed at preventing readmissions.Materials and methodsThis study leverages NSQIP data for 722,101 surgeries to develop predictive and prescriptive models, predicting readmissions and offering real-time, personalized treatment recommendations for surgical patients during their hospital stay, aimed at reducing the risk of a 30-day readmission. We applied a variety of classification methods to predict 30-day readmissions and developed two prescriptive methods to recommend pre-operative blood transfusions to increase the patient's hematocrit with the objective of preventing readmissions. The effect of these interventions was evaluated using several predictive models.ResultsPredictions of 30-day readmissions based on the entire collection of NSQIP variables achieve an out-of-sample accuracy of 87% (Area Under the Curve-AUC). Predictions based only on pre-operative variables have an accuracy of 74% AUC, out-of-sample. Personalized interventions, in the form of pre-operative blood transfusions identified by the prescriptive methods, reduce readmissions by 12%, on average, for patients considered as candidates for pre-operative transfusion (pre-operative hematoctic <30). The prediction accuracy of the proposed models exceeds results in the literature.ConclusionsThis study is among the first to develop a methodology for making specific, data-driven, personalized treatment recommendations to reduce the 30-day readmission rate. The reported predicted reduction in readmissions can lead to more than $20 million in savings in the U.S. annually.

Dataset Information

Effect of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Weight on Emergency Hospitalization and 30-Day Mortality in the General Population.

Publications

Effect of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Weight on Emergency Hospitalization and 30-Day Mortality in the General Population.

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