title: Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials.
abstract: BACKGROUND
  Readmission or death after heart failure (HF) hospitalization is a consequential and closely scrutinized outcome, but risk factors may vary by population. We characterized the risk factors for post-discharge readmission/death in subjects treated for acute heart failure (AHF).
  
  
  RESULTS
  A post hoc analysis was performed on data from 744 subjects enrolled in 3 AHF trials conducted within the Heart Failure Network (HFN): Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE-AHF), Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF). All-cause readmission/death occurred in 26% and 38% of subjects within 30 and 60 days of discharge, respectively. Non-HF cardiovascular causes of readmission were more common in the ≤30-day timeframe than in the 31-60-day timeframe (23% vs 10%, P = .016). In a Cox proportional hazards model adjusting a priori for left ventricular ejection fraction <50% and trial, the risk factors for all-cause readmission/death included: elevated baseline blood urea nitrogen, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) non-use, lower baseline sodium, non-white race, elevated baseline bicarbonate, lower systolic blood pressure at discharge or day 7, depression, increased length of stay, and male sex.
  
  
  CONCLUSIONS
  In an AHF population with prominent congestion and prevalent renal dysfunction, early readmissions were more likely to be due to non-HF cardiovascular causes compared with later readmissions. The association between use of ACEI/ARB and lower all-cause readmission/death in Cox proportional hazards model suggests a role for these drugs to improve post-discharge outcomes in AHF.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri. Electronic address: jvader@dom.wustl.edu.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Vader
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Shane J
authors.initials: SJ
authors.lastname: LaRue
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Mount Sinai Hospital, New York, New York; Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Lala
authors.affiliation: Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
authors.forename: John D
authors.initials: JD
authors.lastname: Groarke
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Omar F
authors.initials: OF
authors.lastname: AbouEzzeddine
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Grodin
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Dávila-Román
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Lisa
authors.initials: L
authors.lastname: de las Fuentes
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002423:Cause of Death; D016208:Databases, Factual; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D014481:United States
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics
keywords: ACE inhibitor; Cardiorenal; RAAS