Abstract 8889: Predictors of 30-Day Readmission in Nonagenarians Presenting With Acute Diastolic Heart Failure: Nationwide Analysis

Abstract

Background: Acute diastolic heart failure (DHF) is a common but poorly studied diagnosis in hospitalized nonagenarians. Objective: To identify predictors of 30-day readmission in nonagenarians hospitalized with acute DHF. Methods: We queried National Readmission Database (NRD) of years 2016-2018 for patients aged 90 or above admitted with acute or acute on chronic DHF. ICD-10 was used to identify diagnoses. We excluded patients discharged in December and those who died in index admission. Univariate regression was performed on each variable. Variables with p value of < 0.2 were included in our multivariate regression model (figure 1). Results: From a total of 45393 index admissions, 43646 (96.2%) survived to discharge. A total of 7437 (16.4%) patients had a 30-day readmission. Mean cost of readmission was 43265 USD per patient. Significant predictors of 30-day readmission were chronic ischemic heart disease (OR=1.11, 95%CI [1.01-1.22], P=0.023), chronic kidney disease stage 3 or above (OR=1.19, 95%CI [1.07-1.34], P=0.002), complicated diabetes (OR=1.22, 95%CI [1.07-1.38], P=0.003), and length of stay (LOS) > 2 days (OR=1.20, 95% CI [1.09-1.32], P=0.000). Female sex (OR=0.90, 95% CI [0.83-0.99], P=0.030) and palliative care visit (OR=0.27, 95% CI [0.21-0.34], P=0.000) were associated with lower odds of readmission. Conclusion: In nonagenarians hospitalized with acute DHF, 30-day readmission is common and costly. Chronic comorbidities and LOS >2 days were predictors of readmission. Palliative care visit was strongly associated with lower risk of readmission. Further strategies need to be developed to improve the quality of care and prevent readmission in this age group.