title: Prior hospital admission predicts thirty-day hospital readmission for heart failure patients.
abstract: BACKGROUND
  Hospital readmission is a significant health burden. More than 20% of heart failure (HF) patients are readmitted within 30 days of discharge leading to billions of dollars in health care expenditures. However, the role of prior hospital admissions to predict 30-day readmission for HF patients is not fully understood.
  
  
  METHODS
  We retrospectively analyzed HF hospitalization data for 4 years at a single medical center. Association between prior admission and 30-day readmission after HF hospitalization was assessed using a multivariate logistic regression model.
  
  
  RESULTS
  A total of 1,999 patients with index HF hospitalizations were identified, and 366 of them (18%) were readmitted within 30 days. The rate of readmission was 14%, 20%, and 33% in patients with 0, 1, ≥ 2 prior admissions. Patients with one prior admission had a 50% higher risk (confidence interval [CI] 1.10-2.05, p = 0.011) for readmission, while those with ≥ 2 prior admissions had a more than 3-fold increase in readmission (CI 2.27-4.09, p < 0.001), after adjustments for relevant clinical covariates. Prior hospital admission provided incremen-tal value in predicting readmissions, shown by the significant improvement in the readmission predictive model (C-statistics increased from 0.57 to 0.63). However, neither the length of stay nor recency of prior admission was a significant factor in predicting readmissions.
  
  
  CONCLUSIONS
  Hospital admission prior to an index HF hospitalization is associated with a significantly increased risk for 30-day hospital readmission and could be used to identify patients at high-risk for readmission and potentially target interventions to reduce the risk of readmission for these patients.
authors.forename: Donald P
authors.initials: DP
authors.lastname: McLaren
authors.forename: Roy
authors.initials: R
authors.lastname: Jones
authors.forename: Ronald
authors.initials: R
authors.lastname: Plotnik
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Scott
authors.initials: S
authors.lastname: McIntosh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Alexis
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.forename: Robert
authors.initials: R
authors.lastname: Block
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lowenstein
authors.affiliation: University of Rochester Medical Center Rochester NY. valentina.kutyifa@heart.rochester.edu.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
mesh_terms: D000368:Aged; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: heart failure; predictive model; prior admissions; readmissions