Abstract 15895: Causes and Predictors of 30-Day Readmission After Implantable Cardioverter/Defibrillator Insertion in Heart Failure Patients: Insight From the National Readmissions Database

Abstract

Introduction: Implantable Cardioverter/Defibrillator (ICD) insertion in heart failure (HF) patients with ejection fraction below 30% and at least 40 days post-infarction is rapidly becoming commonplace. Given the high prevalence of ICD insertions in HF patients with reduced ejection fraction (HFrEF) we aimed to analyze the rates and causes of readmissions in this specific population. Methods: We utilized the National Readmission Database from 2018 to identify hospitalized adults with HF who underwent ICD insertion. We included those who were readmitted within 30 days after the index admission. We excluded elective and traumatic admissions. A multivariate cox regression model was used to identify independent predictors of readmission. Results: During the study period, 283,539 hospitalized patients with HF who underwent ICD insertion were discharged alive. Within 30-days from discharge, 46,537 (16.4%) were readmitted. The top three causes of readmission were heart failure (35.2%), sepsis (5.26%), and ventricular tachycardia (4%). Readmitted patients were more likely to be discharged to nursing facility (45% vs 38%; p<0.001), had higher rates of Medicare/Medicaid (89.2% vs 78.7%; p<0.001) and annual income < $44,000 (35.7% vs 33%; p<0.001). In-hospital mortality (5.6% vs 3.4%; p<0.001) was higher during readmission. Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Conclusions: We identified social and clinical predictors of readmission after ICD insertion in those with HF such as household income, discharge to a nursing home, renal/lung disease, and intubation during their index admission. Healthcare systems should use this data to target modifiable factors to prevent readmissions as this can help ease the burden placed on the resources of the American healthcare system and improve clinical outcomes for patients.