Readmission Rates for Heart Failure in a Safety-Net Hospital

Abstract

Background Despite ongoing efforts, heart failure hospitalization (HFH) rates remain high. The underserved population may be at higher risk for readmission given limited access to health care professionals, advanced device-based therapies, and newer medications. The goal of the current study was to determine HFH rates in an urban Safety-Net hospital and to identify clinical and non-clinical factors that may influence these rates. Methods All patients g 18 years of age admitted to the Coronary Care Unit from March 2017 to February 2018 at Los Angeles County USC Medical Center were indexed in a database. Demographics, insurance status, history of drug use, ejection fraction (EF), etiology of heart failure, treatment received, and length of hospital stay were collected. All-cause and 30-day HFH rates were determined. Results During the study period, 188 patients were identified. Mean age was 58±14 years, 69% were male, 15% had preserved EF, and 35% had an ischemic cardiomyopathy. The prevalence of active tobacco/alcohol use was 42%. Active use of methamphetamines, heroin, cocaine, and/or cannabis was present in 18%. HFH at 30 days for the entire cohort was 17%. Length of hospital stay was 4.2±5.1days. Following the index hospitalization, only 45% of patients returned for a scheduled follow-up outpatient visit. On univariate analysis, current drug use, current alcohol/smoking, and homelessness were associated with an increased HFH rate within 30 days. On multivariate analysis, homelessness was the only independent risk factor associated with HFH (p=0.049). Conclusions Homeless individuals have a significantly increased risk for heart failure hospitalization. Additional interventions focused on improving post-discharge outpatient follow-up rates, targeting continued drug use, and facilitating adequate housing are required in the underserved population.