Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale

Abstract

BackgroundChronic heart failure (CHF), which affects >5 million Americans, accounts for >1 million hospitalizations annually. As a part of the Hospital Readmission Reduction Program, the Affordable Care Act requires that the Centers for Medicare and Medicaid Services reduce payments to hospitals with excess readmissions. This study sought to develop a scale that reliably predicts readmission rates among patients with CHF.MethodsThe State Inpatient Database (2006–2011) was utilized, and discharge data including demographic and clinical characteristics on 642,448 patients with CHF from California and New York (derivation cohort) and 365,359 patients with CHF from Florida and Washington (validation cohort) were extracted. The Readmission After Heart Failure (RAHF) scale was developed to predict readmission risk.ResultsThe 30-day readmission rates were 9.42 and 9.17% (derivation and validation cohorts, respectively). Age <65 years, male gender, first income quartile, African American race, race other than African American or Caucasian, Medicare, Medicaid, self-pay/no insurance, drug abuse, renal failure, chronic pulmonary disorder, diabetes, depression, and fluid and electrolyte disorder were associated with higher readmission risk after hospitalization for CHF. The RAHF scale was created and explained the 95% of readmission variability within the validation cohort. The RAHF scale was then used to define the following three levels of risk for readmission: low (RAHF score <12; 7.58% readmission rate), moderate (RAHF score 12–15; 9.78% readmission rate), and high (RAHF score >15; 12.04% readmission rate). The relative risk of readmission was 1.67 for the high-risk group compared with the low-risk group.ConclusionThe RAHF scale reliably predicts a patient’s 30-day CHF readmission risk based on demographic and clinical factors present upon initial admission. By risk-stratifying patients, using models such as the RAHF scale, strategies tailored to each patient can be implemented to improve patient outcomes and reduce health care costs.

Readmission Risk Factors in Patients after myocardial infarction using the minimum data set

“…According to the present study, the highest rate of readmission was found in 123 male cases (69.43%). In 2018, Ronald Chamberlain et al reported more readmissions in men (15). In a 2014 study by Jeremiah Brown et al, The mean age of patients discharged for acute myocardial infarction was 78.4 with 51.6% male, which is consistent with this study (16).…”

“…Establishing balance between cost of effectiveness and providing high quality care to patients is a constant challenge for modern health care systems (5). In general, hospital readmission is defined as a hospital admission for a specified period of time (7,15,30,60, 90 days or even up to one year), after the initial admission and discharge (6,7). However, the most common time for readmission is 30 days after discharge (7).…”

Risk Factors for Liver Cirrhosis-Related Readmissions in the Largest Ethnic Minority in United States

“…We compared the reason for hospitalization at their Liver Cirrhosis-Related Readmissions in USA Gastroenterol Res. 2020;13(1): [11][12][13][14][15][16][17][18] index hospitalization to the reason for hospitalization during their subsequent visit (Table 4). Ascites and hepatic encephalopathy were the two most common reasons for hospitalization leading to readmissions.…”

“…Liver Cirrhosis-Related Readmissions in USA Gastroenterol Res. 2020;13(1): [11][12][13][14][15][16][17][18] Efforts have been made to identify the risk factors for readmissions related to other diseases like congestive heart failure (CHF) [11]. Various evidence-based interventions targeting those at risk for CHF-related readmissions have been implemented to attain success in reducing the burden of readmission [12].…”

Clinical correlates of hand‐held ultrasound‐guided assessments of the inferior vena cava in patients with acute decompensated heart failure

“…Using the previously reported 30‐day readmission rate of heart failure patients of 9%‐30% (Medicare risk standardized rate 23%) and assuming readmission rates for patients with dilated IVC at discharge to be arbitrarily at >50%, the sample size needed to detect this difference in our study would range from 76 to 116 using a standard statistical sample size calculation (power 80%, alpha error rate 0.05). However, if we looked for a smaller effect size in which we are to assume that US guided inpatient HF management would reduce admissions by half to a third, we would need to enroll 116‐580 patients in the study (power 80%, alpha error 0.05).…”