Etiologies, Trends and Predictors of 30-day readmission in Patients with Heart Failure

• Published in: The American journal of cardiology Vol. 119; no. 5; pp. 760 - 769
• Main Authors: Arora, Shilpkumar, MD, Patel, Prashant, MD, Lahewala, Sopan, MD, Patel, Nilay, MD, Patel, Nileshkumar J., MD, Thakore, Kosha, MD, Amin, Aditi, MD, Tripathi, Byomesh, MD, Kumar, Varun, MD, Shah, Harshil, MD, Shah, Mahek, MD, Panaich, Sidakpal, MD, Deshmukh, Abhishek, MD, Badheka, Apurva, MD, Gidwani, Umesh, MD, Gopalan, Radha, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017; Elsevier Limited
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Anemia; Arrhythmias, Cardiac; Cardiovascular; Chronic Disease; Codes; Comorbidity; Confidence intervals; Coronary Artery Disease; Diabetes; Diabetes Mellitus - epidemiology; Drug abuse; Electrolytes; Family income; Female; Gender; Health maintenance organizations; Heart failure; Heart Failure - epidemiology; HMOs; Hospital Bed Capacity - statistics & numerical data; Hospitals; Hospitals, Teaching - statistics & numerical data; Humans; Income - statistics & numerical data; Insurance, Health - statistics & numerical data; Kidney Diseases; Logistic Models; Lung Diseases; Male; Medicaid; Medicare; Middle Aged; Morbidity; Multivariate analysis; Odds Ratio; Patient Discharge; Patient Readmission - statistics & numerical data; Patient Readmission - trends; Patients; Psychosis; Renal Insufficiency - epidemiology; Risk Factors; Studies; Trends; United States - epidemiology; Variables; Water-Electrolyte Imbalance - epidemiology; Young Adult; United States > US; Heart Failure; Readmission; Etiologies; Predictors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.11.022

Abstract Heart failure (HF) is the most common discharge diagnosis across the US and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the problem. The study cohort was derived from the HCUP’s National Readmission Data (NRD) 2013, sponsored by the AHRQ. HF was identified using appropriate ICD-9-CM codes. Readmission was defined as a subsequent hospital admission within 30-days following discharge day of index admission. Readmission causes were identified by using ICD-9 codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical two level logistic models were used to evaluate study outcomes. From a total 301,892 principle admissions (73.4% age≥65 years and 50.6% male), 55,857(18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by CAD and arrhythmias), while pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (Odds Ratio, 95%-CI, p-value) (1.06, 1.03-1.08, p<0.001), chronic lung disease (1.13, 1.11-1.16, p<0.001), renal failure/electrolyte imbalance (1.12, 1.10-1.15, p<0.001), discharge to facilities (1.07, 1.04-1.09, p <0.001), lengthier hospital stay and transfusion during index admission. In conclusion, readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome.