Predictors of 30‐Day Readmission in Patients Hospitalized With Decompensated Heart Failure

Abstract

Background: Heart failure (HF) is the leading cause of hospitalizations and readmissions in the United States. Approximately one-third of patients admitted for HF are readmitted within 3 months; however, there are few markers that can identify those at highest risk for readmission. The purpose of this study was to identify clinical and laboratory markers associated with hospital readmission in decompensated HF. Hypothesis: Clinical and laboratory markers are associated with readmission rates in decompensated HF. Methods: Clinical and laboratory data from 412 patients admitted with HF were analyzed using a multivariable logistic regression analysis to find predictors of HF readmission by 30 days. Results: HF readmission rates at 30 days were lowest in those with at least 2 of the following discharge criteria: net fluid reduction >1.3 L (odds ratio [OR]: 0.27, P = 0.019), serum sodium level >135 (OR: 0.46, P = 0.034), and N-terminal brain natriuretic peptide level reduction >23% (OR: 0.11, P = 0.048). In multivariate analysis, those patients meeting ≥2 criteria had a very low risk of 30-day readmission (OR: 0.10, 95% confidence interval: 0.01-0.68, P = 0.019) compared to patients who failed to meet 2 criteria. Conclusions: A negative fluid balance, normal serum sodium, and net reduction in N-terminal brain natriuretic peptide level during hospitalization may be important indices to target to help reduce the likelihood of HF readmission within 30 days. IntroductionIn the United States, the estimated prevalence of heart failure (HF) approaches 6 million individuals.1 Despite advances in the medical management of HF, it remains the leading cause of hospitalizations and readmissions. 2 Within 3 months of a HF hospitalization, there is a national 30% readmission rate and an associated 10% mortality rate.

Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation

“…In general, hospitalizations for heart failure are more challenging to predict than mortality [28–32]. These problems may be magnified in the LVAD population, as the LVAD itself introduces many new reasons for why patients may be rehospitalized.…”

Reliability of Predicting Early Hospital Readmission After Discharge for an Acute Coronary Syndrome Using Claims-Based Data

“…Although serum sodium is a known predictor of readmission in patients admitted with acute decompensated heart failure, 26 we found no prior study examining serum sodium levels and readmission following an ACS hospitalization. It may also be that sodium levels are a marker for other clinical morbidity or vulnerability that was not captured in the information available in the current study.…”

ModelHeart: a resident-led implementation of metrics to reduce 30-day heart failure readmissions

“…Hazard regression modelling with receiver-operating curve analyses yielded three inpatient metrics associated with decreased readmissions (table 1). 23 …”

“…Thus, in the absence of a robust risk assessment model to predict increased risk of readmission for patients with HF, there is an ever growing need for studies focusing at identification of clinical and laboratory parameters associated with increased risk of HF readmission and their optimal management. Our group conducted an observational study that identified three discharge metrics (table 1) that resulted in lower incidence of 30-day readmissions for patients with HF 23. The present study is a prospective validation of these discharge criteria with the following objectives:…”