Abstract 21366: Atrial Fibrillation Adversely Affects Readmission Outcomes for Heart Failure: Observations From the Nationwide Readmissions Database

Abstract

Introduction: Atrial fibrillation(AF) and heart failure (HF) often coexist. Readmissions in HF is a rising concern. Hypothesis: AF affects 90-day readmissions following admission for HF. Methods: The Nationwide Readmissions Database (NRD) for 2013 was analyzed for the first readmission within 90-days following discharge with a diagnosis of AF and HF. Clinical Classification Software (CCS) from the Health Care Utilization Project (HCUP) was utilized to investigate leading diagnoses and procedures for readmissions. ICD-9-CM codes were used to identify diagnoses not classified in the CCS. All estimates were weighted using the weight variable provided by HCUP for stratified sampling. Results: In 2013, 885,270 adults were admitted with a primary diagnosis of HF of which 364,447(41%) had AF. After discharge, 90-day all-cause readmission rates were significantly higher in HF patients with coexisting AF (41% vs 38%, p<0.001). Multivariate regression analysis showed that AF was independently associated with an increased likelihood of 90-day readmission after discharge for HF (OR: 1.18, CI: 1.14-1.21). In HF patients with coexisting AF, the primary readmission diagnoses were HF (36%), renal failure (4%), AF (4%), sepsis (4%) and respiratory failure (3%) and the most common procedures performed were cardioversion (16 %), echocardiogram (12 %), coronary revascularization (7%), blood transfusion (6%) and hemodialysis (5%). Mean length of stay during readmission in patients with and without coexisting AF was 5.0 vs 5.5 days (p<0.000, t-test). Mean cost of readmission during readmission in patients with and without coexisting AF was $8693 vs $9386 (p<0.000, t-test). Conclusion: In patients with HF, coexisting AF is associated with higher likelihood of 90-day readmission. Most common causes for such readmissions are decompensated HF, AF and renal failure. Adequately controlled AF may reduce readmissions in HF patients.