title: All-Payer Analysis of Heart Failure Hospitalization 30-Day Readmission: Comorbidities Matter.
abstract: BACKGROUND
  Thirty-day readmission following heart failure hospitalization impacts hospital performance measures and reimbursement. We investigated readmission characteristics and the magnitude of 30-day hospital readmissions after hospital discharge for heart failure using the Healthcare Cost and Utilization Project State Inpatient Databases (SID).
  
  
  METHODS
  Adults aged ≥ 40 years hospitalized with a primary discharge diagnosis of heart failure from 2007-2011 were identified in the California, New York, and Florida SIDs. Characteristics of patients with and without 7-, 8 to 30-, and 30-day readmission, and primary readmission diagnoses and risk factors for readmission were examined.
  
  
  RESULTS
  We identified 547,068 patients with mean age 74.7 years; 50.7% were female, and 65.4% were White. Of 117,123 patients (21.4%) readmitted within 30 days (median 12 days), 69.7% had a non-heart failure primary readmission diagnosis. Patients with 30-day readmissions more frequently had a history of previous admission with heart failure as a secondary diagnosis, fluid and electrolyte disorders, and chronic deficiency anemia. There were no significant clinical differences at baseline between those patients whose first readmission was in the first 7 days after discharge vs in the next 23 days. The most common primary diagnoses for 30-day non-heart failure readmissions were other cardiovascular conditions (14.9%), pulmonary disease (8.5%), and infections (7.7%).
  
  
  CONCLUSIONS
  In this large all-payer cohort, ∼70% of 30-day readmissions were for non-heart failure causes, and the median time to readmission was 12 days. Future interventions to reduce readmissions should focus on common comorbid conditions that contribute to readmission burden.
authors: Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Electronic address: davjon@ohsu.edu.
authors: Jonathan D
authors: JD
authors: Davis
authors: Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Mo; Division of Public Health Sciences, Washington University School of Medicine, Saint Louis, Mo.
authors: Margaret A
authors: MA
authors: Olsen
authors: Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Mo.
authors: Kerry
authors: K
authors: Bommarito
authors: Division of Cardiology, Washington University School of Medicine, Saint Louis, Mo.
authors: Shane J
authors: SJ
authors: LaRue
authors: Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Mo.
authors: Mohammed
authors: M
authors: Saeed
authors: Division of Cardiology, Washington University School of Medicine, Saint Louis, Mo.
authors: Michael W
authors: MW
authors: Rich
authors: Division of Cardiology, Washington University School of Medicine, Saint Louis, Mo.
authors: Justin M
authors: JM
authors: Vader
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005431:Florida / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology
keywords: Heart failure; Patient readmission