Predicting HF Readmissions

Study Questions:

What factors predict a higher risk of heart failure (HF) readmission?

Methods:

This was a cohort study of all patients with a primary discharge diagnosis of HF during a 2-year period at a single tertiary center. The subset of patients who were readmitted were randomly selected and compared with a randomly selected sample of patients not readmitted. A standardized data form including sociodemographic data, comorbidities, medications, insurance, ejection fraction, and biomarker values was completed through chart review by nurses and clinical pharmacists specifically trained for the study. Univariate and multivariate analyses were performed to develop a prediction model.

Results:

The study cohort included 125 HF patients who were readmitted within 30 days and 120 HF patients who were not readmitted. No significant associations were seen between readmission and age, sex, race, left ventricular ejection fraction, serum creatinine, or B-type natriuretic peptide. Significant predictors included the number of medications at discharge and the number of comorbidities. Medication quartiles ranged from fewer than 8 to more than 14 medications. The relative risk of readmission increased with each quartile to 1.7 at the highest number of medications. Patients with three to four comorbidities were over three times more likely to be readmitted; patients with five or more comorbidities had a five-times-greater risk of readmission. Unlike some previous studies, the three comorbidities most strongly associated with readmission were renal insufficiency, atrial fibrillation, and cardiomyopathy.

Conclusions:

This study reveals a simple means of identifying HF patients at greatest risk of readmission. Use of this information can be applied to developing individualized discharge and care-management plans to reduce the risk of readmission for HF.

Perspective:

HF has become a major challenge in contemporary health care. Among Medicare participants, the leading cause of readmission to hospital is HF. The social and economic impact is substantial; reducing HF readmission is a major focus of both The Joint Commission and Centers for Medicare and Medicaid Services. The authors cite evidence that 40% of HF readmissions are considered preventable. Their study has provided additional tools for assessing our patients’ risk of readmission, allowing us to direct our interventions more efficiently to decrease the burden of readmission not only for the system but also, especially, for our patients.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Acute Heart Failure

Keywords: Atrial Fibrillation, Cardiomyopathies, Comorbidity, Heart Defects, Congenital, Heart Failure, Patient Readmission, Renal Insufficiency, Risk Assessment


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