Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 2/2013

01-02-2013 | Reviews

Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

Authors: Linda Calvillo–King, MD, MPH, Danielle Arnold, MD, Kathryn J. Eubank, MD, Matthew Lo, MD, Pete Yunyongying, MD, Heather Stieglitz, PhD, Ethan A. Halm, MD, MPH

Published in: Journal of General Internal Medicine | Issue 2/2013

Login to get access

ABSTRACT

BACKGROUND

Readmission and mortality after hospitalization for community-acquired pneumonia (CAP) and heart failure (HF) are publically reported. This systematic review assessed the impact of social factors on risk of readmission or mortality after hospitalization for CAP and HF—variables outside a hospital’s control.

METHODS

We searched OVID, PubMed and PSYCHINFO for studies from 1980 to 2012. Eligible articles examined the association between social factors and readmission or mortality in patients hospitalized with CAP or HF. We abstracted data on study characteristics, domains of social factors examined, and presence and magnitude of associations.

RESULTS

Seventy-two articles met inclusion criteria (20 CAP, 52 HF). Most CAP studies evaluated age, gender, and race and found older age and non-White race were associated with worse outcomes. The results for gender were mixed. Few studies assessed higher level social factors, but those examined were often, but inconsistently, significantly associated with readmissions after CAP, including lower education, low income, and unemployment, and with mortality after CAP, including low income. For HF, older age was associated with worse outcomes and results for gender were mixed. Non-Whites had more readmissions after HF but decreased mortality. Again, higher level social factors were less frequently studied, but those examined were often, but inconsistently, significantly associated with readmissions, including low socioeconomic status (Medicaid insurance, low income), living situation (home stability rural address), lack of social support, being unmarried and risk behaviors (smoking, cocaine use and medical/visit non-adherence). Similar findings were observed for factors associated with mortality after HF, along with psychiatric comorbidities, lack of home resources and greater distance to hospital.

CONCLUSIONS

A broad range of social factors affect the risk of post-discharge readmission and mortality in CAP and HF. Future research on adverse events after discharge should study social determinants of health.
Literature
1.
2.
Kansagara D, Englander H, Salanitro A, et al. Risk prediction models for hospital readmission: a systematic review. JAMA. 2011;306(15):1688–1698.PubMedCrossRef
3.
Krumholz HM, Wang Y, Mattera JA, et al. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2006;113(13):1693–1701.
4.
Bratzler DW, Normand S-LT, Wang Y, et al. An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients. PLoS One. 2011;6(4):e17401.PubMedCrossRef
5.
Keenan PS, Normand S-LT, Lin Z, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1(1):29–37.PubMedCrossRef
6.
Lindenauer PK, Normand S-LT, Drye EE, et al. Development, validation, and results of a measure of 30-day readmission following hospitalization for pneumonia. J Hosp Med (Online). 2011;6(3):142–150.CrossRef
7.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Heal Soc Behav. 1995;36(1):1–10.CrossRef
8.
Vrbova L, Mamdani M, Moineddin R, Jaakimainen L, Upshur R. Does socioeconomic status affect mortality subsequent to hospital admission for community acquired pneumonia among older persons? J Negat Results Biomed. 2005;4:4.PubMedCrossRef
9.
Philbin E, DiSalvo T. Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure. Am J Cardiol. 1998;82(1):76–81.PubMedCrossRef
10.
Philbin E, DiSalvo T. Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data. J Am Coll Cardiol. 1999;33(6):1560–1566.PubMedCrossRef
11.
Philbin E, DiSalvo T. Managed care for congestive heart failure: influence of payer status on process of care, resource utilization, and short-term outcomes. Am Heart J. 1998;136(3):553–561.PubMedCrossRef
12.
Amarasingham R, Moore BJ, Tabak YP, et al. An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical record data. Med Care. 2010;48(11):981–988.PubMedCrossRef
13.
Schwarz K, Elman C. Identification of factors predictive of hospital readmissions for patients with heart failure. Heart Lung. 2003;32(2):88–99.PubMedCrossRef
14.
Watson AJ, O’Rourke J, Jethwani K, et al. Linking electronic health record-extracted psychosocial data in real-time to risk of readmission for heart failure. Psychosomatics. 2011;52(4):319–327.PubMedCrossRef
15.
Anderson MA, Levsen J, Dusio ME, et al. Evidenced-based factors in readmission of patients with heart failure. J Nurs Care Qual. 2006;21(2):160–167.PubMedCrossRef
16.
Ross JS, Maynard C, Krumholz HM, et al. Use of administrative claims models to assess 30-day mortality among Veterans Health Administration hospitals. Med Care. 2010;48(7):652–658.PubMedCrossRef
17.
Ross JS, Mulvey GK, Stauffer B, et al. Statistical models and patient predictors of readmission for heart failure: a systematic review. Arch Intern Med. 2008;168(13):1371–1386.PubMedCrossRef
18.
Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the New Millennium. Heal Aff. 2009;28(1):75–85.CrossRef
19.
Herzog N, Bratzler D, Houck P, et al. Effects of previous influenza vaccination on subsequent readmission and mortality in elderly patients hospitalized with pneumonia. Am J Med. 2003;115(6):454–461.PubMedCrossRef
20.
Whittle J, Lin C, Lave J, et al. Relationship of provider characteristics to outcomes, process, and costs of care for community-acquired pneumonia. Med Care. 1998;36(7):977–987.PubMedCrossRef
21.
Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011;305(7):675–681.PubMedCrossRef
22.
Jasti H, Mortensen E, Obrosky D, Kapoor W, Fine M. Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis. 2008;46(4):550–556.PubMedCrossRef
23.
McGregor M, Reid R, Schulzer M, Fitzgerald J, Levy A, Cox M. Socioeconomic status and hospital utilization among younger adult pneumonia admissions at a Canadian hospital. BMC Health Serv Res. 2006;6:152.PubMedCrossRef
24.
Kaplan V, Angus D, Griffin M, Clermont G, Scott Watson R, Linde-Zwirble W. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States.[see comment]. Am J Respir Crit Care Med. 2002;165(6):766–772.PubMed
25.
Oliver M, Stukenborg G, Wagner D, et al. Comorbid disease and the effect of race and ethnicity on in-hospital mortality from aspiration pneumonia. J Natl Med Assoc. 2004;96(11):1462–1469.PubMed
26.
Tabak Y, Johannes R, Silber J. Using automated clinical data for risk adjustment: development and validation of six disease-specific mortality predictive models for pay-for-performance. Med Care. 2007;45(8):789–805.PubMedCrossRef
27.
Polsky D, Jha A, Lave J, et al. Short- and long-term mortality after an acute illness for elderly whites and blacks. Health Serv Res. 2008;43(4):1388–1402.PubMedCrossRef
28.
Mortensen E, Cornell J, Whittle J. Racial variations in processes of care for patients with community-acquired pneumonia. BMC Health Serv Res. 2004;4(1):20.PubMedCrossRef
29.
Abrams T, Vaughan-Sarrazin M, Rosenthal G. Variations in the associations between psychiatric comorbidity and hospital mortality according to the method of identifying psychiatric diagnoses. J Gen Intern Med. 2008;23(3):317–322.PubMedCrossRef
30.
Saitz R, Ghali W, Moskowitz M. The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med. 1997;157(13):1446–1452.PubMedCrossRef
31.
de Roux A, Cavalcanti M, Marcos M, et al. Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia. Chest. 2006;129(5):1219–1225.PubMedCrossRef
32.
Vaughan-Sarrazin M, Wakefield B, Rosenthal G. Mortality of Department of Veterans Affairs patients admitted to private sector hospitals for 5 common medical conditions. Am J Med Qual. 2007;22(3):186–197.PubMedCrossRef
33.
Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure.[see comment]. Arch Intern Med. 2001;161(15):1849–1856.PubMedCrossRef
34.
Kossovsky M, Sarasin F, Perneger T, Chopard P, Sigaud P, Gaspoz J. Unplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics? Am J Med. 2000;109(5):386–390.PubMedCrossRef
35.
Opasich C, Cafiero M, Scherillo M, et al. Impact of diabetes on the current in-hospital management of heart failure. From the TEMISTOCLE study. Ital Heart J. 2003;4(10):685–694.PubMed
36.
Roe-Prior P. Sociodemographic variables predicting poor post-discharge outcomes for hospitalized elders with heart failure. Medsurg Nurs. 2007;16(5):317–321.PubMed
37.
Rathore S, Foody J, Wang Y, et al. Race, quality of care, and outcomes of elderly patients hospitalized with heart failure.[see comment]. JAMA. 2003;289(19):2517–2524.PubMedCrossRef
38.
Kociol RD, Greiner MA, Hammill BG, et al. Long-term outcomes of medicare beneficiaries with worsening renal function during hospitalization for heart failure. Am J Cardiol. 2010;105(12):1786–1793.PubMedCrossRef
39.
Rodriguez F, Joynt KE, Lopez L, Saldana F, Jha AK. Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction. Am Heart J. 2011;162(2):254–261.e253.PubMedCrossRef
40.
Aranda JM Jr, Johnson JW, Conti JB. Current trends in heart failure readmission rates: analysis of Medicare data. Clin Cardiol. 2009;32(1):47–52.PubMedCrossRef
41.
Luthi J, Lund M, Sampietro-Colom L, Kleinbaum D, Ballard D, McClellan W. Readmissions and the quality of care in patients hospitalized with heart failure. Int J Qual Health Care. 2003;15(5):413–421.PubMedCrossRef
42.
Krumholz H, Parent E, Tu N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. [see comment]. Arch Intern Med. 1997;157(1):99–104.PubMedCrossRef
43.
Howie-Esquivel J, Dracup K. Does oxygen saturation or distance walked predict rehospitalization in heart failure? J Cardiovasc Nurs. 2008;23(4):349–356.PubMed
44.
Philbin E, Dec G, Jenkins P, DiSalvo T. Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol. 2001;87(12):1367–1371.PubMedCrossRef
45.
Rathore S, Masoudi F, Wang Y, et al. Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project. Am Heart J. 2006;152(2):371–378.PubMedCrossRef
46.
Tsuchihashi M, Tsutsui H, Kodama K, et al. Medical and socioenvironmental predictors of hospital readmission in patients with congestive heart failure. Am Heart J. 2001;142(4):E7.PubMedCrossRef
47.
Albert NM, Fonarow GC, Abraham WT, et al. Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. Am J Med. 2009;122(4):366–373.PubMedCrossRef
48.
Struthers A, Anderson G, Donnan P, MacDonald T. Social deprivation increases cardiac hospitalisations in chronic heart failure independent of disease severity and diuretic non-adherence. Heart. 2000;83(1):12–16.PubMedCrossRef
49.
Chioncel O, Vinereanu D, Datcu M, et al. The Romanian Acute Heart Failure Syndromes (RO-AHFS) registry. Am Heart J. 2011;162(1):142–153.e141.PubMedCrossRef
50.
Saczynski JS, Darling CE, Spencer FA, Lessard D, Gore JM, Goldberg RJ. Clinical features, treatment practices, and hospital and long-term outcomes of older patients hospitalized with decompensated heart failure: The Worcester Heart Failure Study. J Am Geriatr Soc. 2009;57(9):1587–1594.PubMedCrossRef
51.
Feinglass J, Martin G, Lin E, Johnson M, Gheorghiade M. Is heart failure survival improving? Evidence from 2323 elderly patients hospitalized between 1989–2000. Am Heart J. 2003;146(1):111–114.PubMedCrossRef
52.
Garty M, Shotan A, Gottlieb S, et al. The management, early and one year outcome in hospitalized patients with heart failure: a national Heart Failure Survey in Israel–HFSIS 2003. Isr Med Assoc J. 2007;9(4):227–233.PubMed
53.
Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting Mortality Among Patients Hospitalized for Heart Failure: Derivation and Validation of a Clinical Model. JAMA. 2003;290(19):2581–2587.PubMedCrossRef
54.
Goldberg R, Spencer F, Farmer C, Meyer T, Pezzella S. Incidence and hospital death rates associated with heart failure: a community-wide perspective. Am J Med. 2005;118(7):728–734.PubMedCrossRef
55.
Zuccala G, Pedone C, Cesari M, et al. The effects of cognitive impairment on mortality among hospitalized patients with heart failure.[see comment]. Am J Med. 2003;115(2):97–103.PubMedCrossRef
56.
Pearson M, Kahn K, Harrison E, et al. Differences in quality of care for hospitalized elderly men and women. JAMA. 1992;268(14):1883–1889.PubMedCrossRef
57.
Ni H, Nauman D, Hershberger R. Managed care and outcomes of hospitalization among elderly patients with congestive heart failure. Arch Intern Med. 1998;158(11):1231–1236.PubMedCrossRef
58.
Fonarow G, Abraham W, Albert N, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008;168(8):847–854.PubMedCrossRef
59.
Ambardekar AV, Fonarow GC, Hernandez AF, et al. Characteristics and in-hospital outcomes for nonadherent patients with heart failure: findings from Get With The Guidelines-Heart Failure (GWTG-HF). Am Heart J. 2009;158(4):644–652.PubMedCrossRef
60.
Zuluaga MC, Guallar-Castillon P, Conthe P, et al. Housing conditions and mortality in older patients hospitalized for heart failure. Am Heart J. 2011;161(5):950–955.PubMedCrossRef
61.
Torres J, Cardenas O, Vasquez A, Schlossberg D. Streptococcus pneumoniae bacteremia in a community hospital.[see comment]. Chest. 1998;113(2):387–390.PubMedCrossRef
62.
Bohannon R, Maljanian R. Hospital readmissions of elderly patients hospitalized with pneumonia. Conn Med. 2003;67(10):599–603.PubMed
63.
El Solh A, Pineda L, Bouquin P, Mankowski C. Determinants of short and long term functional recovery after hospitalization for community-acquired pneumonia in the elderly: role of inflammatory markers. BMC Geriatr. 2006;6:12.PubMedCrossRef
64.
Vinson J, Rich M, Sperry J, Shah A, McNamara T. Early readmission of elderly patients with congestive heart failure.[see comment]. J Am Geriatr Soc. 1990;38(12):1290–1295.PubMed
65.
Afzal A, Ananthasubramaniam K, Sharma N, et al. Racial differences in patients with heart failure. Clin Cardiol. 1999;22(12):791–794.PubMedCrossRef
66.
Krumholz H, Chen Y, Wang Y, Vaccarino V, Radford M, Horwitz R. Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J. 2000;139(1 Pt 1):72–77.PubMedCrossRef
67.
Chen M, Chang H, Cheng C, Chen Y, Chai H. Risk stratification of in-hospital mortality in patients hospitalized for chronic congestive heart failure secondary to non-ischemic cardiomyopathy. Cardiology. 2003;100(3):136–142.PubMedCrossRef
68.
Formiga F, Chivite D, Sole A, Manito N, Ramon J, Pujol R. Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF). A prospective study. Arch Gerontol Geriatr. 2006;43(2):175–185.PubMedCrossRef
69.
Luttik M, Jaarsma T, Veeger N, van Veldhuisen D. Marital status, quality of life, and clinical outcome in patients with heart failure. Heart Lung. 2006;35(1):3–8.PubMedCrossRef
70.
Howie-Esquivel J, Dracup K. Effect of gender, ethnicity, pulmonary disease, and symptom stability on rehospitalization in patients with heart failure. Am J Cardiol. 2007;100(7):1139–1144.PubMedCrossRef
71.
Najafi F, Dobson A, Jamrozik K. Recent changes in heart failure hospitalisations in Australia. Eur J Heart Fail. 2007;9(3):228–233.PubMedCrossRef
72.
Mullens W, Abrahams Z, Sokos G, et al. Gender differences in patients admitted with advanced decompensated heart failure. Am J Cardiol. 2008;102(4):454–458.PubMedCrossRef
73.
Lofvenmark C, Mattiasson A-C, Billing E, Edner M. Perceived loneliness and social support in patients with chronic heart failure. Eur J Cardiovasc Nurs. 2009;8(4):251–258.PubMedCrossRef
74.
Moser DK, Yamokoski L, Sun JL, et al. Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure. J Card Fail. 2009;15(9):763–769.PubMedCrossRef
75.
Muus KJ, Knudson A, Klug MG, Gokun J, Sarrazin M, Kaboli P. Effect of post-discharge follow-up care on re-admissions among US veterans with congestive heart failure: a rural–urban comparison. Rural Remote Heal. 2010;10(2):1447.
76.
Akosah K, Schaper A, Haus L, Mathiason M, Barnhart S, McHugh V. Improving outcomes in heart failure in the community: long-term survival benefit of a disease-management program. Chest. 2005;127(6):2042–2048.PubMedCrossRef
77.
Alberts MJ, Bhatt DL, Mas J-L, et al. Three-year follow-up and event rates in the international Reduction of Atherothrombosis for Continued Health Registry. Eur Heart J. 2009;30(19):2318–2326.PubMedCrossRef
Metadata
Title
Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review
Authors
Linda Calvillo–King, MD, MPH
Danielle Arnold, MD
Kathryn J. Eubank, MD
Matthew Lo, MD
Pete Yunyongying, MD
Heather Stieglitz, PhD
Ethan A. Halm, MD, MPH
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 2/2013
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-012-2235-x

Other articles of this Issue 2/2013

Journal of General Internal Medicine 2/2013 Go to the issue

Clinical Practice: Clinical Vignettes

A Peculiar Cause of Anaphylaxis: No More steak?

Healing Arts: Materia Medica

Haunted by the Unread

Original Research

Paced Respiration for Vasomotor and Other Menopausal Symptoms: A Randomized, Controlled Trial

Innovation and Improvement: Improvement Happens

Improvement Happens: A Commercial IT Solution for Reviving Primary Care? An Interview with Hello Health CEO Nathanial Findlay and Colleagues

Original Research

Prediction of Recovery, Dependence or Death in Elders Who Become Disabled During Hospitalization

Original Research

Unannounced Standardized Patient Assessment of the Roter Interaction Analysis System: The Challenge of Measuring Patient-Centered Communication
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits