Abstract 266: Impact of Bleeding on 30-Day All Cause Readmission in Atrial Fibrillation Patients

Abstract

OBJECTIVES: To determine the impact of hospital acquired bleeding assessed in patients admitted for atrial fibrillation (AF) on 30-day all-cause readmission. METHODS: The Premier research database was queried to identify adult inpatients discharged between 2008 and 2011 who had a primary diagnosis code for AF and in whom bleeding was not present on admission. Bleeding was identified using ICD-9 diagnosis codes, charge codes for fresh frozen plasma or blood, or charge codes for transfusion of blood or blood components. Descriptive statistics including the outcome of 30-day all-cause readmission were obtained. For comparing patients with and without bleeding, t-tests for continuous variables and chi-squared tests for categorical variables were used (alpha = 0.05). Logistic regression adjusting for demographics, comorbidities and antiplatelet/anticoagulant use were used to produce odds ratio estimates for the odds of a patient having a readmission when comparing patients with and without bleeding. RESULTS: There were 143,287 patients, average age of 69.4 (SD 14.5) that met the study criteria. Overall, 2,991 (2.1%) patients had a bleed during their hospitalization. There were 142,138 (99.2%) patients eligible for a readmission defined as not having died during the index hospitalization. The unadjusted 30-day readmission rate was 21.1% in patients with a bleed compared to 10.8% in the no bleeding group (p-value <0.0001) with an odds ratio of 2.22 (95% CI 2.02-2.43). The adjusted odds ratio of having a 30-day readmission was 1.48 (95% CI 1.34-1.62) when comparing the bleed group to the no bleed group. Sensitivity analyses adjusting for cardiac related procedures resulted in numerical differences in the estimates, but not the direction or significance of the outcomes. Overall, the most prevalent primary diagnosis upon readmission was atrial fibrillation (23.5%), followed by heart failure NOS (4.5%), and pneumonia (3.8%). CONCLUSIONS: Occurrence of bleeding in hospitalized patients with AF is associated with a significant increase in 30-day readmission. More research is needed to determine whether strategies to decrease bleeding can positively improve readmission rates for this patient population.