Abstract P320: Congestive Heart Failure Readmissions: Relationship Between Preadmission Patient Determinants and 30 Day Rehospitalization

Abstract

Introduction Congestive heart failure (CHF) is the most costly disease in the US. Readmission costs contribute significantly to this healthcare expenditure. While adherence to published guidelines has increased, readmission rates have not improved. There is an urgent need to identify clinical and process measures that improve care for CHF patients. Thirty day readmission rates have often been used by third party payers as a surrogate index for quality of care in the inpatients settings. This study looked at the relationship between preadmission patient characteristics and 30 day readmissions. Methods: This was a single center retrospective case-control study that evaluated 6063 consecutive patients admitted with a diagnosis of CHF from December 2001 through December 2008. Data was abstracted for independent and dependent variables, including heart failure performance measures at discharge. This Ad hoc analysis focused on the relationship between patient determinants on 30 day readmissions. Statistical comparison was made between readmitted and non readmitted cohorts. Results: There were 6063 total patients admitted with the principal diagnosis of CHF. A total of 19.6% (1191 of 6063) of the patients were readmitted within 30 days of discharge. Another 19.9% (1211 of 6063) served as control cohort. The mean age for readmitted and non readmitted patients was 77.8(+/- 11.6) and 75.7 (+/- 11.8) years respectively. Mean duration of initial hospital stay for readmitted patients was 5.7 (+/- 4) days and 6.0 (+/-4) days for the control group. Readmitted patients were more likely to be smokers than their counterparts. (O.R= 1.5, 95% CI 1.2-1.9 p=0.002).Non usage of ACEI medication prior to hospitalization was associated with higher rates of readmission (O.R 1.30, 95% CI 1.1-1.6, p=0.003).However beta blocker therapy did not correlate with 30 day readmissions. (O.R 1.0, 95% CI 0.89- 1.19, p=0.970). Conclusions: In patients admitted with CHF, non usage of ACEI prior to hospitalization and smoking history may serve as indicators for early readmissions. Preadmission beta blocker use was not associated with reduced early readmissions. More studies need to be done to stratify determinants that identify patients at risk for early readmissions.