title: Multimorbidity and the Risk of All-Cause 30-Day Readmission in the Setting of Multidisciplinary Management of Chronic Heart Failure: A Retrospective Analysis of 830 Hospitalized Patients in Australia.
abstract: Multimorbidity has an adverse effect on health outcomes in hospitalized individuals with chronic heart failure (CHF), but the modulating effect of multidisciplinary management is unknown.
  
  
  
  The aim of this study was to test the hypothesis that increasing morbidity would independently predict an increasing risk of 30-day readmission despite multidisciplinary management of CHF.
  
  
  
  We studied patients hospitalized for any reason with heart failure receiving nurse-led, postdischarge multidisciplinary management. We profiled a matrix of expected comorbidities involving the most common coexisting conditions associated with CHF and examined the relationship between multimorbidity and 30-day all-cause readmission.
  
  
  
  A total of 830 patients (mean age 73 ± 13 years and 65% men) were assessed. Multimorbidity was common, with an average of 6.6 ± 2.4 comorbid conditions with sex-based differences in prevalence of 4 of 10 conditions. Within 30 days of initial hospitalization, 216 of 830 (26%) patients were readmitted for any reason. Greater multimorbidity was associated with increasing readmission (4%-44% for those with 0-1 to 8-9 morbid conditions; adjusted odds ratio, 1.25; 95% confidence interval, 1.13-1.38) for each additional condition. Three distinct classes of patient emerged: class 1-diabetes, metabolic, and mood disorders; class 2-renal impairment; and class 3-low with relatively fewer comorbid conditions. Classes 1 and 2 had higher 30-day readmission than class 3 did (adjusted P < .01 for both comparisons).
  
  
  
  These data affirm that multimorbidity is common in adult CHF inpatients and in potentially distinct patterns linked to outcome. Overall, greater multimorbidity is associated with a higher risk of 30-day all-cause readmission despite high-quality multidisciplinary management. More innovative approaches to target-specific clusters of multimorbidity are required to improve health outcomes in affected individuals.
authors.affiliation: Joshua F. Wiley, PhD Postdoctoral Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Yih-Kai Chan, PhD Research Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Yasmin Ahamed, PhD Postdoctoral Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Jocasta Ball, PhD NHMRC/NHFA Early Career Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Melinda J. Carrington, PhD Associate Professor, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Barbara Riegel, PhD Professor, University of Pennsylvania School of Nursing, Philadelphia. Simon Stewart, PhD Director, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Wiley
authors.forename: Yih-Kai
authors.initials: YK
authors.lastname: Chan
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ahamed
authors.forename: Jocasta
authors.initials: J
authors.lastname: Ball
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology; D019964:Mood Disorders / Q000453:epidemiology; D000076322:Multimorbidity; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology