Impact of Hospital Readmissions on Subsequent Mortality: a Temporal Trend Analysis of Hospital Admissions for Acute Heart Failure

Abstract

Background: Patients admitted to hospital with acute heart failure (AHF) are at increased risk of readmission and mortality post-discharge. This study assessed the impact of hospital readmissions on subsequent mortality rates in patients discharged from hospital with AHF. Methods: Sixteen Victorian hospitals participated in a prospective statewide HF snapshot of patients admitted to hospital with AHF over one month and followed up for 30 days post-discharge. The project was conducted annually over three consecutive years from 2015–2017. Results: Of the 1197 patients, 56.3% were male with an average age of 77 years (SD 13.17 years). Hypertension, chronic renal disease and atrial fibrillation were the most common comorbidities (75.2%, 64% and 54.7%, respectively). Overall 50.4% of patients were admitted to General Medicine and 33.9% to Cardiology. In-hospital mortality rate was 5.1% with 30 day-mortality of 4.2% and readmission rate of 24.4%. Patients who experienced a subsequent readmission within 10 days of discharge from index hospitalisation had a 4.6-fold increase in risk of mortality (adjusted HR 4.6, 95% CI 2.16–9.81) compared to patients who were not readmitted and patients readmitted within 11–20 days post-discharge had a 4.3-fold increase in risk of mortality (adjusted HR 4.36, 95% CI 2.04–9.27). Conclusion: Patients admitted to hospital with AHF who experience a subsequent readmission within 20 days post-discharge are at increased risk of dying. It is vital that early post-discharge follow-up within 20 days is implemented to address this vulnerable period after an HF admission.