Discharge to an extended care facility, black race, and prior history of heart failure were independent predictors of 30-day all-cause readmission, with ECF discharge increasing odds by 2.4-fold.
Cohort (n=712)
No
Effect estimate: OR 2.4 (95% CI 1.54-3.73)
p-value: p=<0.001
Heart failure (HF) is the most common hospital discharge diagnosis among the elderly. It accounts for nearly 1. 4 million hospitalizations and 21 billion in spending per year in the United States. Readmission rates remain high with estimates ranging from 15-day readmission rates of 13%, 30- day readmission rates of 25%, to 6-month readmission rates of 50%. The Center for Medicare and Medicaid Services (CMS) has started penalizing hospitals with higher than expected readmission rates. Objective: To identify factors associated with increased 30-day readmission among heart failure patients in an inner-city community-based teaching hospital. Methods: A retrospective cohort study of patients with principal discharge diagnosis of acute Heart Failure between 2008 and 2010. Demographic, clinical characteristics, length of stay, discharge medications, disposition and all-cause 30-day readmission were abstracted from the hospital’s administrative database and analyzed. Results: Almost 8 out of 10 patients were 65 years or older (mean age 75. 4 ± 14. 3) and 51% were female. The in-hospital mortality rate was 2. 7% (95% confidence interval CI, 1. 6% - 4. 3%) with a median length of stay of 5. 0 days (Interquartile range of 3 - 7). The all-cause 30-day readmission rate was 17. 7% (95% CI 14. 9% - 20. 8%). By univariate analysis, readmissions were predicted by black race, prior history of HF, length of stay of more than 7 days and discharge to extended care facility (ECF). By logistic regression analysis, black race (OR 2. 4, 95% CI 1. 4 - 3. 8), prior history of HF (OR 1. 7, 95% CI 1. 5 - 2. 6) and discharge to an ECF (OR 2. 4, 95% CI 1. 5 - 3. 7) were the independent predictors of 30-day readmission. HF accounted for 43. 7% of the readmissions. Conclusion: Prior diagnosis of HF, black race, and discharge to an ECF were independent predictors of 30-day readmission in this cohort, and over half of the readmissions were for reasons other than HF.
Xexemeku et al. (Wed,) conducted a cohort in Heart Failure (n=712). Discharge to an extended care facility (ECF) vs. Discharge to home/other was evaluated on 30-day all-cause readmission (OR 2.4, 95% CI 1.54-3.73, p=<0.001). Discharge to an extended care facility, black race, and prior history of heart failure were independent predictors of 30-day all-cause readmission, with ECF discharge increasing odds by 2.4-fold.