Single-center Veterans Hospital Heart Failure Study: Heart Failure Readmissions And New-York Heart Association (NYHA) Class Related To Increased Mortality

Abstract

Background Currently, more than 6.2 million individuals in the United States are diagnosed with congestive heart failure (CHF). CHF readmission rates are associated with higher mortality rates and economic burden. After a hospitalization for decompensated heart failure, the 30-day, 1-year, and 5-year mortality rates are 10%, 20-30% and 42-50%, respectively. By 2030, the cost for CHF is predicted to be around 70 billion dollars per year. Methods Retrospective chart review was completed on patients admitted at James A. Haley Veterans Hospital in Tampa, Florida for a CHF admission between 1/1/20 to 7/31/20. Predictors of overall survival (OS), including readmission status and comorbid conditions, were assessed using the Cox proportional hazards multivariate regression analysis. Hazard ratio (HR) and 95% confidence intervals (95% CI) were reported. The OS was calculated from first admission to last follow up or death. Patients were stratified into two groups based on CHF readmission status. There was a total of 100 patients in the study. Results The non-readmission group had on average longer OS duration (mean: 275 days, 95% CI: 260 to 290) compared to readmission group (mean: 230 days, 95% CI: 193 to 268) (p value: 0.01). Patients discharged on guide-line directed medical therapy (GDMT) with beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker had superior OS (HR: 0.27, 95% CI: 0.10-0.74). In Cox proportional hazards multivariate regression analysis, the patients with higher NYHA class (HR: 2.59, 95% CI: 1.03 to 6.52) and patients who were re-admitted (HR: 0.21, 95% CI: 0.07 to 0.60) experienced poor OS. Conclusions : Readmission and higher NYHA class were related to lower OS. These results highlight the need to implement quality improvement measures to prevent readmissions in addition to utilizing GDMT. Quality improvement measures aimed at identifying these high-risk patients and initiating early intervention may improve overall outcomes. Currently, more than 6.2 million individuals in the United States are diagnosed with congestive heart failure (CHF). CHF readmission rates are associated with higher mortality rates and economic burden. After a hospitalization for decompensated heart failure, the 30-day, 1-year, and 5-year mortality rates are 10%, 20-30% and 42-50%, respectively. By 2030, the cost for CHF is predicted to be around 70 billion dollars per year. Retrospective chart review was completed on patients admitted at James A. Haley Veterans Hospital in Tampa, Florida for a CHF admission between 1/1/20 to 7/31/20. Predictors of overall survival (OS), including readmission status and comorbid conditions, were assessed using the Cox proportional hazards multivariate regression analysis. Hazard ratio (HR) and 95% confidence intervals (95% CI) were reported. The OS was calculated from first admission to last follow up or death. Patients were stratified into two groups based on CHF readmission status. There was a total of 100 patients in the study. The non-readmission group had on average longer OS duration (mean: 275 days, 95% CI: 260 to 290) compared to readmission group (mean: 230 days, 95% CI: 193 to 268) (p value: 0.01). Patients discharged on guide-line directed medical therapy (GDMT) with beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker had superior OS (HR: 0.27, 95% CI: 0.10-0.74). In Cox proportional hazards multivariate regression analysis, the patients with higher NYHA class (HR: 2.59, 95% CI: 1.03 to 6.52) and patients who were re-admitted (HR: 0.21, 95% CI: 0.07 to 0.60) experienced poor OS. : Readmission and higher NYHA class were related to lower OS. These results highlight the need to implement quality improvement measures to prevent readmissions in addition to utilizing GDMT. Quality improvement measures aimed at identifying these high-risk patients and initiating early intervention may improve overall outcomes.