IJCS | Volume 33, Nº2, March / April 2020

182 Sarteschi et al. Predictors of post-discharge 30-day readmission Int J Cardiovasc Sci. 2020; 33(2):175-184 Original Article Economic and social aspects were not considered in this study, since it was based on a historical cohort, with medical record data. The operation of these variables, from the quantitative point of view, was limited both by the inexistence of information and by the quality and reliability of the information present on the medical records. Ziaian concluded, in his article, that the risk of hospital readmission is also related to the behavior of healthcare professionals, such as strategies that lead to greater support to discharging patients, better communication and earlier outpatient care. 29 Another factor that has an influence on hospital readmission rates is the hospital structure. In the Bergethon study, university hospitals presented higher relative readmission rate in comparison with their peers, and the hospitals that used disease management programs had lower relative readmission rates. 31 It is very important to validate the reproduction of literature findings in our own population, as we are dealing with patients from the private health system and it is well known that their socio-economic and clinical profile differ from those of the patients seen by the public health system, besides the access to healthcare, which is very distinct between the two groups of patients. According to official data from the National Health Agency of Brazil, in 2003, the private health system received around 35 million beneficiaries. In 2016, this number raised to 48 million, an increase of 37% in 13 years. 32 The private health system has been crucial to the State, as it supports the National Health System itself, helping to meet the national demand for healthcare. The data must be interpreted from the light of its limitations. The study was based on only one hospital facility, even though that facility is a reference in cardiology treatments in the North and Northeast of Brazil, where there is still some lack of information. The size of the sample group was limited, and the data was taken from medical records, implying that all relevant data were registered precisely, however, unknown prognostic factors or the ones not registered may have influenced the results. As stated previously, it is possible to recognize that, according to several discussed studies, there is no single model of risk prediction of hospital readmission fromHF. The epidemiological and clinical characteristics of each population require local validation of those risk tools as a way to find out the relevant predictors to complement clinical practice in determining the best care to be given to patients with that syndrome. From this perspective, in the context of a healthcare system with a multidisciplinary profile capable of offering full patient assistance, taking in consideration all biological, psychological and social determinants, it is important to have a follow-up plan to support patients and families. In a sample of patients admitted at the private health system with DHF, the readmission rate was over 20%, and factors such as reduced left ventricular ejection fraction, hyponatremia and ACS as causes of decompensation were strong markers of hospital readmission within 30 days of discharge. Acknowledgement and evaluation of these findings are helpful for policymaking in the public healthcare system, with actions aiming at treatment and care for those patients. The healthcare and scientific communities must practice critical epidemiology based on a wider comprehension of reality, seeking better evidence in order to protect life and not only health. Author contributions Conception and design of the research: Sarteschi C, Cesse EAP, Martins SM. Acquisition of data: Sarteschi C, Medeiros C. Analysis and interpretation of the data: Sarteschi C, Martins SM. Statistical analysis: Sarteschi C. Obtaining financing: Sarteschi C. Writing of the manuscript: Sarteschi C. Critical revision of the manuscript for intellectual content: Sarteschi C, Cesse EAP, Martins SM, Souza WV. Supervision / as the major investigador: Sarteschi C. Potential Conflicts of Interest There are no relevant conflicts of interest to be declared. Funding Sources The present study was funded by Capes. Academic Association The present study is part of a PhD thesis by Sarteschi C., presented to Programa de Pos-Graduação em Saúde Pública do Centro de Pesquisas Aggeu Magalhães – Fiocruz/PE.