Predictors of Early Readmission in Heart Failure Patients in an Inner-City Community Hospital

Abstract

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.