213 - Discharge Readiness Assessment and 6-month Readmission Risk in Acute Decompensated Heart Failure

Abstract

Background: Attention has been paid recently to the short-term effects of discharging patients admitted for acute decompensated heart failure (ADHF) prior to achieving euvolemia, but long-term effects remain unknown. This study evaluated the influence of the discharge volume status assessment on readmissions over 6 months. Methods: This was a retrospective cohort study of 100 consecutive adult patients discharged from a single academic hospital admission for management of ADHF from May, 2014 to June, 2015. Exclusion criteria included characteristics of the patient (ESRD on HD, congenital heart disease, or LVAD in place) and the hospitalization (discharge within 6 months of index admission or surgery/death during hospitalization). Baseline characteristics were obtained from the admission H&P and primary data reports. Discharge characteristics were obtained solely from the discharge summary (DS). Co-primary outcomes were 6-month readmission for all-cause and HF as primary diagnosis, assessed by chart review. Comparisons were made by chi-square testing for categorical variables and independent samples t-testing or Kruskal-Wallis testing for continuous variables. Results: Mean age was 62.1 years (SD 15.3), 44% were women, and the average BMI was 33.9 kg/m2 (SD 11.6). Hypertension (87%), history of tobacco use (68%), hyperlipidemia (59%), coronary artery disease (44%), and diabetes (42%) were common. Ejection fraction was preserved (>40%) in 46%. All-cause 6-month readmission occurred in 51% and HF-related 6-month readmissions occurred in 38%. In the DS physical exam, traditional markers of volume status were documented at similar rates in those who were and were not readmitted, except for absence of edema, which was more commonly documented in those not readmitted (82.6 vs. 56.3%, P = .04). A clear discussion in the DS that the patient had achieved euvolemia was similarly documented between those readmitted and those not (17.6 vs. 18.4%, P = .93). In the DS assessment section, no markers of volume status to justify discharge reached statistical significance except dyspnea resolution, which was more commonly cited in those not readmitted (40.8 vs. 23.5%, P = .06). These differences remained significant if HF was the primary readmission diagnosis. Conclusions: The presence or absence of clinical euvolemia as measured by DS physical exam and heart failure assessment was not associated with readmission rate. This long-term outcome possibly reflects long-term disease severity rather than the management practices during a singular admission.