Key result
Hospital stay over 7 days is linked to ~7.9-fold higher 90-day readmission in HFrEF.
Why the study?
Recurrent hospitalizations in HFrEF compromise patient outcomes and burden healthcare systems, and identifying predictors of 90-day readmission enables treatment optimization for high-risk patients.
Do clinical, laboratory, and treatment factors (such as length of stay, CKD, hemoglobin, LVEF, and SGLT2 inhibitor use) predict 90-day readmission in patients hospitalized for ADHF with LVEF ≤40%?
Cohort (n=180)
No
Do clinical, laboratory, and treatment factors (such as length of stay, CKD, hemoglobin, LVEF, and SGLT2 inhibitor use) predict 90-day readmission in patients hospitalized for ADHF with LVEF ≤40%?
In patients hospitalized for acute decompensated HFrEF, prolonged length of stay (>7 days), prior CKD, lower LVEF, lower admission hemoglobin, and lack of inpatient SGLT2 inhibitor initiation independently predict 90-day readmission.
May aid HFrEF readmission risk stratification; hypothesis-generating and requires prospective validation before practice change.
Background: Heart failure with Reduced Ejection Fraction (HFrEF) is a chronic condition frequently associated with recurrent hospitalizations. These readmissions compromise patient outcomes and impose significant burdens on healthcare systems. Identifying high-risk HFrEF patients enables treatment optimization. This single-center analytical study investigates predictors of 90-day readmission after hospitalization in HFrEF patients. Methods: This retrospective cohort study enrolled patients with Left Ventricular Ejection Fraction (LVEF) ?40% who were admitted to the Cardiology Department Emergency Room at Adam Malik General Hospital for Acute Decompensated Heart Failure (ADHF) from January 2023 to January 2025 using consecutive sampling, followed for 90 days post-discharge. Statistical analyses included Mann-Whitney U, independent t-tests, chi-square, and backward stepwise multivariate logistic regression. Results: Of 180 patients (71 rehospitalized, 109 non-rehospitalized), multivariate analysis identified five independent predictors of 90-day readmission: Length of Stay (LOS) >7 days (p<0.001, OR 7.854, 95% CI 3.216-19.179), prior Chronic Kidney Disease (CKD) (p=0.008, OR 3.989, 95% CI 1.430-11.131), lower LVEF (p<0.001, OR 0.844, 95% CI 0.777-0.916), Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitor non-use (p=0.006, OR 0.116, 95% CI 0.025-0.544), and lower admission Hemoglobin (Hb) (p=0.028, OR 0.803, 95% CI 0.661-0.976). Kaplan-Meier analysis revealed significant differences in 90-day rehospitalization-free survival across clinical subgroups. Rehospitalized patients had a median survival of 42 days versus 72 days for non-rehospitalized patients (log-rank p<0.001). SGLT2 inhibitor users during index hospitalization showed the strongest curve separation despite a small sample (n=4 vs n=15; log-rank p=0.002), while prolonged LOS >7 days, CKD, and anemia independently predicted worse outcomes (all log-rank p<0.001). Conclusions: In HFrEF patients, longer LOS >7 days, prior CKD, lower LVEF, lower admission Hb, and lack of inpatient SGLT2 inhibitor use independently predicted 90-day readmission.
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Ridwan et al. (2026) conducted a cohort in Acute Decompensated Heart Failure with Reduced Ejection Fraction (LVEF ≤40%) (n=180). Length of stay >7 days vs. Length of stay ≤7 days was evaluated on 90-day all-cause rehospitalization (OR 7.854, 95% CI 3.216-19.179, p=<0.001). Hospital length of stay >7 days (OR 7.854), CKD (OR 3.989), lower LVEF (OR 0.844), lower Hb (OR 0.803), and inpatient SGLT2i use (OR 0.116) independently predicted 90-day readmission in HFrEF.
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