Association Between Frailty and 30-day Unplanned Readmission After Hospitalization for Heart Failure: Results from Nationwide Readmissions Database

Abstract

<h3>Purpose</h3> Frailty is associated with adverse hospital outcomes in heart failure (HF) patients. This study examines the association between frailty, readmission, and other relevant hospital outcomes using a national database. <h3>Methods</h3> This is a retrospective analysis of the Nationwide Readmissions Database from 2010 to 2014. Patients ≥65 years of age admitted for HF were included in the study. We used the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. The primary outcome of the study was 30-day unplanned readmission rate. <h3>Results</h3> A total of 819,854 patients were admitted for HF, of which 63,302 (7.7%) were frail. Frail patients, 22,382 (35.4%) experienced unplanned readmission within 30 days after index hospitalization, as compared to non-frail patients, 168,797 (22.3%, P<0.001). Trend analysis showed that the relative decrease rates of unplanned 30-day readmission decreased for both frail (7.8%) and non-frail (6.9%) patients during the study period. Among HF patients who experienced unplanned 30-day readmission, mortality rates (16.2% versus 8.2%, P<0.001) and hospitalization cost ($13,616 versus $9,876, P<0.001) were higher among frail patients, compared to non-frail patients. Besides HF, most common reasons for unplanned 30-day readmission among frail HF patients were septicemia (11.2%), and acute renal failure (5.1%). Regression analysis showed that the risk for unplanned 30-day readmission was higher in patients with frailty (OR, 1.18; 95% CI, 1.14-1.22). Other risk factors for unplanned 30-day readmission were comorbidity index >3, AMI, CAD, arrhythmia, diabetes mellitus, cancer, chronic lung disease, chronic renal disease, liver disease, fluid and electrolyte disorder, anemia, coagulation disorder, and vasopressor use. <h3>Conclusion</h3> Frailty among elderly patients hospitalized for HF is associated with increased readmission, mortality, and cost. Identifying frailty in this population could improve quality of care and decrease hospital burden.