title: Effect of the readmission primary diagnosis and time interval in heart failure patients: analysis of English administrative data.
abstract: OBJECTIVE
  To compare the predictors of unplanned readmission by primary diagnosis and time since discharge in heart failure (HF) patients.
  
  
  RESULTS
  We used national hospital administrative data for England to analyse unplanned readmission by primary diagnosis (HF and non-HF) at 7, 30, 90, 182, and 365 days after the index discharge. A total of 84 212 adult patients had their first HF admission between April 2008 and March 2010; 14 104 (16.8%) died during the index admission and were excluded. Of the remaining 70 108, half were readmitted and 28.7% died during 1 year from discharge (overall mortality rate of 40.6%). Patients had an average of three co-morbidities. Hierarchical logistic regression showed that arrhythmias [odds ratio (OR) = 1.13] and valvular disease (OR = 1.12) had significantly higher odds only for HF readmission; dementia (OR = 1.29), stroke (OR = 1.29), and mental health conditions (OR = 1.25) had higher odds only for non-HF. Ischaemic heart disease, renal disease, and chronic lung disease predicted both. Same-day discharge occurred for 6% of patients and was strongly associated with higher readmission for HF at 7 days, less so thereafter, and not for non-HF after 7 days. Other relationships changed little between 7 and 365 days. Prior outpatient non-attendance was associated with 5-10% higher odds of any readmission per appointment missed.
  
  
  CONCLUSIONS
  In HF patients, some predictors of readmission for HF, especially some common co-morbidities, differ from those for non-HF. In contrast, the time since discharge made little difference to the results.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Co-morbidities; Heart failure; Readmissions