title: The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry.
abstract: OBJECTIVE
  Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial.
  
  
  RESULTS
  Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age.
  
  
  CONCLUSIONS
  A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.
authors.affiliation: Cardiology Department, Istituti Ospitalieri, Cremona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.affiliation: CNR Clinical Physiology Institute, Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.affiliation: ANMCO Research Centre, Florence, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.affiliation: Cardiology Department, Ospedale San Filippo Neri, Rome, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.affiliation: Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Cardiovascular Rehabilitation, Heart Failure Unit, Ospedale Maggiore SS, Trinità, Fossano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.affiliation: Cardiology Department, Ospedali Riuniti, Umberto I-Lancisi-Salesi, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marini
authors.affiliation: Cardiology, Ospedale Santa Maria Nuova, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Milli
authors.affiliation: Cardiology Department, Ospedale dell'Annunziata, Cosenza, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Misuraca
authors.affiliation: Cardiology Department, Policlinico di Monza, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mortara
authors.affiliation: Cardiologia 2 Heart Failure and Heart Transplant Programme, 'A. De Gasperis' Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.affiliation: Heart Failure Clinic, 1st Cardiology/CCU Unit, Cardiovascular Department, San Camillo Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.affiliation: Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Russo
authors.affiliation: Cardiovascular Department, Cardiology 1, Papa Giovanni XXIII Hospital, Bergamo.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Maria Cecilia Hospital-GVM Care&Research-E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries
keywords: 30-Day readmission; Acute heart failure; Days-alive-out-of-hospital; mortality