Early Unplanned Readmissions after Admission to Hospital with Heart Failure

Hospital readmissions remain a continued challenge in the care of patients with heart failure (HF). This study aims to examine the rates, temporal trends, predictors and causes of 30-day unplanned readmissions after admission with HF. Patients hospitalized with a primary or secondary diagnosis of HF in the U.S. Nationwide Readmission Database were included. We examined the incidence, trends, predictors and causes of unplanned all-cause readmissions at 30-days. A total of 3,264,082 and 8,724,846 patients were included in the analyses for primary and secondary diagnoses of HF, respectively. The 30-day unplanned readmission rate was 15.1% for primary HF and 14.6% for secondary HF. Predictors of readmission in primary HF included renal failure (OR 1.27 (1.25-1.28)), cancer (OR 1.26 (1.22-1.29)), receipt of circulatory support (OR 2.81 (1.64-4.81)) and discharge against medical advice (OR 2.29 (2.20-2.39)). In secondary HF, the major predictors were receipt of circulatory support (OR 1.43 (1.12-1.84)) and discharge against medical advice (OR 2.01 95%CI (1.95-2.07)). In primary HF 52.4% of patients were readmitted for a non-cardiac cause while for secondary HF 73.9% were readmitted for a non-cardiac cause. For secondary HF, the strongest predictor of readmission was discharge against medical advice (OR 2.06 95%CI 2.01-2.12, p<0.001). Early unplanned readmissions are common among patients hospitalized with HF, and a majority of readmissions are due to causes other than HF. Our results highlight the need to better manage comorbidities in patients with HF.