Thirty‐Day All‐Cause Readmissions After Pregnancy‐Associated Hospitalizations With Heart Failure in the United States: Analysis of the Nationwide Readmissions Database

Background Cardiovascular disease is the leading cause of pregnancy‐related morbidity and mortality in the United States. There is a paucity of data regarding pregnancy‐associated heart failure readmissions. This study aims to characterize the 30‐day heart failure readmission patterns in pregnancy‐associated admissions. Methods The National Readmission Database from 2016 to 2021 was used to identify women aged 13 to 49 with an index hospitalization with heart failure as the primary or secondary diagnosis during a pregnancy‐related admission, identified by diagnosis‐related group codes and International Classification of Diseases, Tenth Revision ( ICD‐10 ) codes. The primary outcome was 30‐day all‐cause readmission. Survey‐weighted descriptive analyses and hierarchical multivariable logistic regression were used to characterize readmission patterns and identify independently associated factors. Results Among 19 452 eligible index hospitalizations, 2659 were followed by a 30‐day readmission; the survey‐weighted readmission rate was 13.5%. In the fully adjusted model, Medicare and Medicaid coverage, residence in a small metropolitan area, greater All Patient Refined Diagnosis‐Related Group severity, discharge with home health care, and discharge against medical advice were associated with higher odds of readmission. Deficiency anemia, chronic pulmonary disease, diabetes without chronic complications, renal failure, solid tumor without metastasis, and cardiovascular or respiratory disorders complicating pregnancy were also independently associated with increased readmission. Conclusions Approximately 1 in 7 pregnancy‐associated hospitalizations complicated by heart failure was followed by a 30‐day all‐cause readmission. Readmission risk reflected a combination of illness severity, discharge disposition, payer status, geographic location, and selected medical and pregnancy‐related comorbidities. These findings support the development and evaluation of individualized, multidisciplinary transitional‐care strategies for patients at highest risk.