Impact of COPD, Pulmonary Hypertension, and Other Comorbidities on 30-Day Readmissions in African-American Patients With Acute Decompensated Heart Failure

Abstract

PURPOSE: Heart Failure (HF) is more prevalent in African Americans (AAs) than in Non Hispanic whites and imposes a higher rate of morbidity, mortality and 30-day readmissions. In general cohorts, AAs have also been shown to have a higher prevalence of concomitant comorbidities including chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PH) and others. However, there is paucity of data looking at the impact of these conditions in AAs with acute decompensated heart failure (ADHF). The purpose of this study is to describe clinical characteristics, comorbidities, indices of cardiac structure and function, and their impact on 30-day readmission rates in an urban AA population admitted with ADHF. METHODS: A retrospective cohort analysis was conducted using data from AA patients admitted to our facility with a diagnosis of ADHF from 1/1/14 to 3/31/14. 30-day readmission incidence was documented if a patient was admitted for any cause, within 30 days of their index admission, to one of our 4 affiliate hospitals in Chicago, including ours. Chi-square, t-test, Fishers exact and multivariate regression models were applied to determine predictors of readmission including patient demographics, comorbidities, laboratory data and Doppler echocardiographic indices. RESULTS: 140 AA patients were admitted with a diagnosis of ADHF during the study period of which 84 (60%) comprised of heart failure with preserved ejection fraction (HFpEF) and 56 (40%) of heart failure with reduced ejection fraction (HFrEF). Overall, 31 (22.1%) patients were readmitted within 30 days of which 22 (71%) were of HFpEF and 9 (29%) of HFrEF variety. Patients who were readmitted were significantly older (73.03 AE 2.7, p<0.02), more likely to have COPD (40.5%, p<0.002), higher pulmonary artery systolic pressure (PASP) (45.82 AE 2.1, p<0.001) and higher tricuspid regurgitant velocity (TRV) (3.08 AE 0.13, p<0.001) on Doppler echocardiography along with elevated serum N-terminal pro-brain natriuretic peptide (NT-proBNP) (31.3%, p<0.001), compared to those who were not readmitted. Multivariate regression model revealed significant independent predictors of 30-day readmission including a prior diagnosis of COPD (OR: 3.62, p<0.01), a combination of PASP greater than 36 mmHg and TRV greater than 2.8 m/s (OR: 5.27, p<0.001), elevated NT-proBNP (OR: 4.24, p<0.02), and age greater than 70 years (OR: 3.08, p<0.02). CONCLUSIONS: Advanced age, COPD, PH and elevated NT-proBNP are associated with higher incidence of 30-day readmission among AA patients with ADHF. CLINICAL IMPLICATIONS: Identification and optimization of characteristics associated with HF readmissions prior to discharge can potentially reduce HF related morbidity, mortality and overall healthcare expenditure.