Specific Causes of 30-Day and 1-Year Readmissions in Heart Failure Patients

Abstract

Background Readmission rates are a major metric used in evaluating the quality of hospital care for heart failure patients, but the specific causes of readmission are uncertain. Much of the existing data focuses on all-cause readmissions or uses ICD classification coding to determine causes for readmission. In this study, we retrospectively review heart failure cases to identify the specific causes of 30-day and 1-year readmission. Methods We identified heart failure patients from the University of Maryland Medical Center with an index hospitalization between January 2017 - March 2017. All charts were reviewed to determine if the index hospitalization was for heart failure. The charts were then reviewed to determine causes of subsequent readmissions. 30-day and 1-year readmissions were recorded. Readmissions were categorized as due to heart failure exacerbation, other cardiac causes, non-cardiac chest pain, infections, GI disorders, neurological disorders, renal disorders, pulmonary disorders, or trauma and surgical conditions. Planned readmissions were excluded. Results A total of 232 patients were identified to have an index heart failure hospitalization in the specified time frame. 21% of patients were readmitted within 30 days. Heart failure exacerbation, other cardiac causes, and infections were the leading causes of 30-day readmission, representing 53%, 16%, and 14% of 30-day readmissions respectively. 53% of the cohort had at least 1 readmission over 1 year. There was a total of 330 readmissions over 1 year. Heart failure exacerbation, infections, and non-cardiac chest pain were the leading causes of 1-year readmission, representing 40%, 16%, and 8% of 1-year readmissions. Discussion Heart failure exacerbation was the leading cause of both 30-day and 1-year readmissions, but infections, other cardiac causes, and non-cardiac chest pain were also significant contributors to readmissions after an index heart failure hospitalization. Prevention of readmissions necessitates addressing non-cardiac causes as well as heart failure status.