Prior hospital admission predicts thirty-day hospital readmission for heart failure patients

Abstract

Background: Hospital readmission is a significant health burden. More than 20% of heart failure (HF) patients are readmitted within 30 days of discharge leading to billions of dollars in health care expenditures. However, the role of prior hospital admissions to predict 30-day readmission for HF patients is not fully understood. Methods: We retrospectively analyzed HF hospitalization data for 4 years at a single medical center. Association between prior admission and 30-day readmission after HF hospitalization was assessed using a multivariate logistic regression model. Results: A total of 1,999 patients with index HF hospitalizations were identified, and 366 of them (18%) were readmitted within 30 days. The rate of readmission was 14%, 20%, and 33% in patients with 0, 1, ≥ 2 prior admissions. Patients with one prior admission had a 50% higher risk (confidence interval [CI] 1.10–2.05, p = 0.011) for readmission, while those with ≥ 2 prior admissions had a more than 3-fold increase in readmission (CI 2.27–4.09, p < 0.001), after adjustments for relevant clinical covariates. Prior hospital admission provided incremental value in predicting readmissions, shown by the significant improvement in the readmission predictive model (C-statistics increased from 0.57 to 0.63). However, neither the length of stay nor recency of prior admission was a significant factor in predicting readmissions. Conclusions: Hospital admission prior to an index HF hospitalization is associated with a significantly increased risk for 30-day hospital readmission and could be used to identify patients at high-risk for readmission and potentially target interventions to reduce the risk of readmission for these patients.