Abstract 14034: 30-day Readmission Rates of Cardiogenic Shock: A Nationwide Analysis of Inpatient Demographics and Clinical Outcomes

Abstract

Introduction Cardiogenic shock (CS) is a common medical emergency that causes significant morbidity and mortality. Our aim was to characterize patient demographics and analyze the factors that increase the likelihood for CS readmissions. Methods This was a retrospective cohort study using the 2019 Nationwide Readmissions Database (NRD) database to identify admissions in adults with principal diagnosis of CS. Results The index CS admission cohort was 62.2% males, mean age 66.9 years. Of 146,254 index admissions with CS, 19,238 (20.4%) were readmitted. 30-day mortality rate (MR) of index admission was 35.4%, with a MR of 9.7% in those readmitted. The most common cause for readmissions was acute heart failure (26.7%). Patients with the lowest median household income, Medicare, and Medicaid insurance were more likely to be readmitted (1.10 OR 95% CI 1.04 -1.16, p <0.01, 1.17 OR 95% CI 1.11-1.24, p <0.001 and 1.27 OR 95% CI 1.12-1.86, p <0.001 respectively). Meanwhile, being in the highest median household income quartile (>75 th ) or having private insurance were protective against readmission. Acute MI patients were less likely to be readmitted (0.83 OR 95% CI 0.79 -0.87, p <0.001). Diastolic HF and CHF were associated with increased odds of readmission when adjusted for other comorbidities, age, and gender (2.52 OR 95% CI 1.09-5.83, p<0.031 and 2.15 OR 95% CI 1.01-4.57, p<0.046 respectively). Conclusion Readmission after CS is common, with high mortality. Risk factors for readmission include lower household income and Medicare/Medicaid insurance, and those that leave AMA after index cardiogenic shock admission have increased odds of readmission. Conversely, those with the highest median household income and with private insurance had a significantly lower rate of readmission. Additional research is needed to elucidate the contributing factors for this stark difference.