DETERMINANTS OF HOSPITAL
READMISSION WITH HEART FAILURE S P Wright*, H Walsh, G Gamble, N Sharpe, R N Doughty Dept of Medicine, University of Auckland, Auckland, New Zealand. Background:
Heart failure is characterised by frequent hospital readmissions, at the cost
of ~1% of total annual healthcare expenditure. The role of clinical and
socio-demographic features on readmission rates are uncertain. This study
investigated determinants of time to first readmission after an index admission
for heart failure. Methods:
Determinants of hospital readmission were studied in a prospectively identified
cohort of 197 patients hospitalised for an exacerbation of HF. The cohort was
recruited into a post-discharge interventional study which did not effect
hospital readmission in the first 3 months. Determinants of readmission were
determined using non-parametric univariate and multiple regression techniques. Results:
197 patients were included: mean age 73 (SD 10.5), 60% male, 68% NYHA class 4;
55% had 1 or more prior admissions for heart failure, 79% were caucasian. The
median time to first readmission was 65 days (IQR 25, 184). 13% of the cohort
were readmitted within 2 weeks after the index admission. Factors associated
with readmission in the first two weeks on included the number of previous
admissions with HF; the dose of frusemide at discharge from index admission;
LVEDD and LVESD. 38% of the cohort were re-admitted within 65 days. Factors
associated with readmission within 65 days included number of previous admissions
with HF and frusemide dose at discharge. Group allocation to usual care or the
HF management intervention (follow-up in a dedicated hospital-based clinic) had
no effect on readmission at 2 weeks (p=0.9) or 65 days (p=1.0). On multivariate
analysis, factors associated with shorter time to readmission included the
presence of angina; orthopnea or a raised JVP at previous discharge; and length
of stay during the index admission. Conclusion:
Patients with HF who still have signs of peripheral congestion at the time of
discharge and those with a long stay during their index admission are at high
risk of readmission within the first 2 months after discharge. Clinical
pathways in HF should target discharge planning to patients with prolonged
hospital stays. The effects of increased primary-secondary care integration
needs to be re-assessed in this group of patients at high risk of readmission.
