title: Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure.
abstract: Heart failure (HF) is the most common discharge diagnosis across the United States, and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the problem. The study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data 2013, sponsored by the Agency for Healthcare Research and Quality. HF was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Readmission was defined as a subsequent hospital admission within 30 days after discharge day of index admission. Readmission causes were identified using International Classification of Diseases, Ninth Revision, codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. From a total 301,892 principal admissions (73.4% age ≥65 years and 50.6% men), 55,857 (18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by coronary artery disease and arrhythmias), whereas pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (odds ratio, 95% confidence interval, p value: 1.06, 1.03 to 1.08, p <0.001), chronic lung disease (1.13, 1.11 to 1.16, p <0.001), renal failure/electrolyte imbalance (1.12, 1.10 to 1.15, p <0.001), discharge to facilities (1.07, 1.04 to 1.09, p <0.001), lengthier hospital stay, and transfusion during index admission. In conclusion, readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome.
authors.affiliation: Department of Internal Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York. Electronic address: dr.shilparora@yahoo.com.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cardiology Department, University of Southern California, Los Angeles, California.
authors.forename: Prashant
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, RWJ Barnabas Health/Jersey City Medical Center, Jersey City, New Jersey.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Kosha
authors.initials: K
authors.lastname: Thakore
authors.affiliation: Department of Internal Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Aditi
authors.initials: A
authors.lastname: Amin
authors.affiliation: Department of Internal Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Byomesh
authors.initials: B
authors.lastname: Tripathi
authors.affiliation: Department of Internal Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Varun
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Harshil
authors.initials: H
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania.
authors.forename: Mahek
authors.initials: M
authors.lastname: Shah
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal
authors.initials: S
authors.lastname: Panaich
authors.affiliation: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cardiology Department, The Everett Clinic, Everett, Washington.
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.affiliation: Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Umesh
authors.initials: U
authors.lastname: Gidwani
authors.affiliation: Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Radha
authors.initials: R
authors.lastname: Gopalan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac; D002908:Chronic Disease; D015897:Comorbidity; D003324:Coronary Artery Disease; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D007674:Kidney Diseases; D016015:Logistic Models; D008171:Lung Diseases; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D051437:Renal Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology*; D055815:Young Adult