Association of Home Monitoring and Unanticipated Interstage Readmissions in Infants With Hypoplastic Left Heart Syndrome

• Published in: Journal of the American Heart Association Vol. 12; no. 8; p. e025686
• Main Authors: Shustak, Rachel J, Faerber, Jennifer A, Stagg, Alyson, Hehir, David A, Natarajan, Shobha S, Preminger, Tamar J, Szwast, Anita, Rome, Jonathan J, Giglia, Therese M, Ravishankar, Chitra, Mercer-Rosa, Laura, Gardner, Monique M
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 18-04-2023; Wiley
• Subjects: Cohort Studies; congenital heart disease; hospital readmission; Humans; hypoplastic left heart syndrome; Hypoplastic Left Heart Syndrome - diagnosis; Hypoplastic Left Heart Syndrome - surgery; Infant; interstage period; inverse probability weighted; Original Research; Patient Readmission; Retrospective Studies; Risk Factors; Treatment Outcome; Univentricular Heart - complications; congenital heart disease; inverse probability weighted; hospital readmission; hypoplastic left heart syndrome; interstage period
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.122.025686

Background The impact of home monitoring on unanticipated interstage readmissions in infants with hypoplastic left heart syndrome has not been previously studied. We sought to examine the association of our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP) with readmission frequency, cumulative readmission days, and readmission illness severity and to identify patient-level risk factors for readmission. Methods and Results We performed a retrospective single-center cohort study comparing infants with hypoplastic left heart syndrome enrolled in ISVMP (December 2010-December 2019) to historical controls (January 2007-November 2010). The primary outcome was number of readmissions per interstage days. Secondary outcomes were cumulative interstage readmission days and occurrence of severe readmissions. Inverse probability weighted and multivariable generalized linear models were used to examine the association between ISVMP and the outcomes. We compared 198 infants in the ISVMP to 128 historical controls. Infants in the ISVMP had more than double the risk of interstage readmission compared with controls (adjusted incidence rate ratio, 2.38 [95% CI, 1.50-3.78];
=0.0003). There was no difference in cumulative interstage readmission days (adjusted incidence rate ratio, 1.02 [95% CI, 0.69-1.50];
=0.90); however, infants in the ISVMP were less likely to have severe readmissions (adjusted odds ratio, 0.28 [95% CI, 0.11-0.68];
=0.005). Other factors independently associated with number of readmissions included residing closer to our center, younger gestational age, genetic syndrome, and discharge on exclusive enteral feeds. Conclusions Infants in the ISVMP had more frequent readmissions but comparable readmission days and fewer severe unanticipated readmissions. These findings suggest that home monitoring can reduce interstage morbidity without increasing readmission days.