242 Exploratory Analysis of 30-day Emergency Department Revisits and Readmissions by Heart Failure Patients

Abstract

Admission for heart failure (HF) is associated with high post-discharge mortality, re-hospitalization, and cost. For Medicare beneficiaries, HF is the most common cause of admission and re-admission and consumes the greatest proportion of Medicare dollars. 30-day all-cause readmission of HF patients is a key national, publically reported quality measure, and is associated with financial penalties. Importantly however, HF patients have significant cardiac and non-cardiac co-morbid conditions, and may present to the emergency department (ED) for reasons other than HF. A better understanding of why recently discharged HF patients return to the ED is needed. This may present opportunities for targeted interventions to decrease re-admissions. To characterize the frequency and nature of 30-day ED revisits by patients with a past history of HF hospitalization Exploratory, retrospective, descriptive analysis of the Northwestern Enterprise Data Warehouse (EDW), a relational database of all medical data sources associated with a single, urban, academic, tertiary, level 1 trauma center, with ∼85,000 ED visits & ∼55,000 hospital admissions per year. All patients with a principal HF diagnosis from 1999 to 2009 were screened for a return ED visit during a consecutive 60-day period in 2009. Patients were categorized by principle discharge diagnosis: (HF, cardiovascular excluding HF, (CV non-HF), and other) as well as disposition from the ED: (discharge, observation, admission). HF admissions were further evaluated for 30-day ED re-visits. There were 691 ED encounters by 490 patients with a history of past HF admission over the last 10 years, during the 60-day exploratory period (mean visits per patient = 1.43). Approximately 25% of patients had at least 1 re-visit to the ED within 60 days. Acute HF (acute heart failure) accounted for 10.4% (n=72) of ED encounters, with 15.9% for CV non-HF and 73.7% for other reasons. Among subsequently admitted patients, 14.9% had a principal discharge diagnosis of HF, 17.4% for CV non-HF, and 67.7% other. For patients admitted with HF, nearly half (41.7%) had more than 1 re-visit during the 60-day study period. Amongst patients with at least 1 acute heart failure ED presentation, more than half (58.3%) of ED re-visits were for acute HF. Of the 24 index admissions for acute heart failure, 62.5% of patients returned to the ED within 30 days of discharge (21 re-visits to the ED by 15 patients). Of these 30-day ED re-visits, 23.8% were discharged home (approximately 1% were admitted to observation), while the remaining patients were re-admitted, 56.3% for acute heart failure, 12.5% were CV non-HF, and 31.3% for other reasons. In this exploratory analysis of patients with a past history of hospitalization for HF, acute HF is not the primary driver of presentation to the ED. However, in patients who initially present with acute heart failure, heart failure is the primary reason why they subsequently return to the ED. Nevertheless, a sizable proportion of 30-day re-admissions are for reasons other than acute heart failure.