Frequent hospital readmissions during first 3 months post-discharge in HF patients in real-world setting
Hospital readmission of patients with heart failure from real world timing and associated risk factors
Introduction and methods
HF is a disease of the elderly and changing demographics of the population cause an increase in absolute numbers of patients with HF . Health care costs due to hospitalizations for HF are high [2,3]. This economic burden is expected to increase further, because a larger number of people is reaching a higher age.
Identification of high-impact users of the health care system (defined as three or more emergency hospital admissions within a year) has been challenging and risk prediction models have various limitations, i.e. they are often based upon results from RCT populations and are therefore an incorrect representative of the general population that develop HF [4,5]. Furthermore, there are limited data about the time-window of and risk factors involved in hospitalization of patients with HF in Sweden. This study assessed the timing of all-cause and HF hospital readmissions and related risk factors in a real-world cohort of patients with HF.
This retrospective study included patients (n=448) who were admitted to the Sahlgrenska University Hospital/Östra in Gothenburg, Sweden in 2016 and who received a primary diagnosis of HF. Patients had to live in the Västra Götaland region. Patients’ characteristics, such as co-morbidities, laboratory parameters, and physical parameters were collected in a pre-specified form. The time to first all-cause or HF readmission at 1 month, 3 months, 6 months, and 1 year and number of readmissions during 1 year were analyzed. Patients were also stratified to the number of co-morbidities to compare the risk of 1 month and 1 year all-cause or HF readmission between patients with >3 co-morbidities and ≤3 co-morbidities. Follow-up was 1 year.
- The all-cause readmission rate at 1 month, 3 months, 6 months, and 1 year was 20.3%, 36.6%, 47.1%, and 60.9%, respectively. For HF readmissions, the rate was 11.4%, 21.0%, 29.2%, and 38.4% for the same time-periods, respectively. Worsening HF constituted 63% of all-cause readmissions at 1 year follow-up.
- 60.1% Of all-cause readmissions occurred within the first 3 months after discharge from the hospital. The all-cause readmission rate in the second, third and fourth quarters was 17.2%, 15.4%, and 7.3%, respectively.
- HF readmissions was 54.7% in the first quarter. HF readmissions in the second, third, and fourth quarters were 21.5%, 14.5%, and 9.3%, respectively.
- Pulmonary disease, anemia, renal dysfunction, and psychiatric disease were more common in patients who were within 1 year readmitted to the hospital compared to those without a readmission. Psychiatric disease was an independent risk factor for all-cause readmissions within 1 month and 1 year. Also, pulmonary disease, systemic inflammatory disease, elevated NT-proBNP, treatment with nitrates, and follow-up in primary care were independent risk factors of 1 year all-cause readmissions.
- Poor compliance to medication was an independent predictor for HF readmissions within 1 month and 1 year (P=0.002). Inflammatory disease (P=0.045) and use of MRA (P=0.044) or nitrates (P=0.009)) were also predictors of 1 year HF readmissions.
- Patients with HF and more than 3 co-morbidities had an increased risk for all-cause hospital readmission at 1 month (HR 2.15, 95% CI:1.33-3.48, P=0.002), 1 year (HR 1.75, 95% CI:1.36-2.27, P<0.001), and 1 year HF readmission (HR 1.53, 95% CI:1.10-2.11, P=0.011) compared to patients with ≤3 co-morbidities.
- Patients with HF and >3 co-morbidities had an increased risk for 1 year mortality compared to patients with HF and ≤3 co-morbidities (log-rank P<0.001). The 1 month mortality risk was similar between the two groups.
This 1 year follow-up study of a real-world cohort of patients with HF showed that hospital readmissions frequently occurred early (first quarter) after discharge and were mainly caused by worsening HF. Number of co-morbidities was an important risk factor for readmissions, except for HF readmissions within the first month.
The authors state that many hospital readmissions could be prevented by selectively targeting high-risk patients with HF and directing them towards appropriate interventions.