Readmission rates following heart failure: a scoping review of sex and gender based considerations

Abstract

Background: Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender. Methods: We conducted a scoping review using the Arksey and O'Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis. Results: The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/ abstract; 88% full text; kappa: 0.69 (95%CI: 0.53-0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year. Conclusions: Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Cointerventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.

The Female Sex Confers Different Prognosis in Heart Failure: Same Mortality but More Readmissions

“…These results may be associated with previously described differences in pharmacological treatment. A meta-analysis found more articles reporting that men with HF had significantly higher readmission rates compared to women ( 47 ). The effect of sex on readmission may depend on the length of follow-up, with a longer duration of follow-up favoring higher readmission rates among men.…”

“…The effect of sex on readmission may depend on the length of follow-up, with a longer duration of follow-up favoring higher readmission rates among men. Thus, Hoang-Kim et al ( 47 ) reported that the readmission rate for men was higher when the duration of follow-up was >1 year. In contrast, women were more likely to experience higher readmission rates than men when the time to event was <1 year.…”

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

“…Although HF incidence is initially higher in men, women survive longer after the onset of the disease [ 24 ]. A recent review reported that female patients with HF were more likely to experience higher readmission rates than men when the time-span was less than a year [ 27 ]. However, the female’s contribution to the prognosis of HF has frequently been underestimated in many randomized controlled trials due to the exclusion of extreme clinical variables that are dominant in females [ 24 , 26 ].…”

“…As per prior studies [ 16 , 17 ], diabetes mellitus, hypertension, and thyroid disease are prevalent among women, whereas AF is more frequent in men. Unfortunately, sex differences in clinical characteristics and adverse outcomes in HF patients with AF have received limited attention [ 26 , 27 ].…”

“…Accordingly, healthcare professionals should examine the factors that can cause adverse outcomes in older patients with HF. Evidence regarding the 90-day readmission rates are not as well established as compared to 30-day readmissions and 1-year follow-ups in Korea and other countries [ 27 ]. Particularly, the 90-day period after discharge may be more critical for observation of readmission and healthcare utilization during the vulnerable phase among the real-world Korean patients with HF [ 10 ].…”