The biomedical, socioeconomic and demographic predictors of heart failure readmissions

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Sydney Local Health District Introduction Heart failure hospitalisations and readmissions pose a significant clinical and economic burden internationally. Current studies support a range of biomedical and sociodemographic factors as predictors of HF readmissions; however, there are a paucity of studies synthesising the research on this topic. Purpose The purpose of this systematic review was to identify biomedical, socioeconomic and demographic predictors of heart failure-related readmissions in adults with heart failure. Methods Electronic databases (Medline, Embase and Scopus) were searched using a structured search strategy. The particular risk factors of interest were left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) function class, brain natriuretic peptide (BNP), heart rate, blood pressure, employment status, income, age, sex, ethnicity, indigenous status, marital status, and socioeconomic indexes for areas (SEIFA) scores. After the removal of duplicates, the article selection process was conducted by two independent authors according to an inclusion and exclusion criteria. The articles were first filtered by title and abstract against the inclusion and exclusion criteria. The remaining articles were then assessed by reviewing the studies in full text. The relevant Critical Appraisal Skills Programme (CASP) tools were then used to appraise the final articles included for review. Results In total 1,516 papers were retrieved from the search. Of the 1,516 papers, 666 were from Medline, 567 were from CINAHL, 282 were from Embase, and one paper was from an independent search. After the removal of duplicates, 1296 papers were filtered according to title and abstract and 1183 papers were excluded from this process. 95 papers were assessed by reading them in full and of the 95 papers, 77 were excluded. This resulted in eighteen studies being included for review. Unemployment was the only socioeconomic factor predictive of HF readmissions (HR = 1.09; 95%CI= 1.05-1.14; p = 0.03) and SEIFA scores did not predict HF readmissions in adults with HF (p > 0.05). Indigenous status was a risk factor of HF readmissions according to one study (p < 0.05). Age or sex did not affect the risk of HF readmissions in adults with HF (p > 0.05). NYHA function class, BNP levels, and heart rate predicted HF readmissions in the population of interest. LVEF and blood pressure were non-significant predictors of HF readmissions (p > 0.05). Conclusions Current HF guidelines have a strong biomedical focus in the management of HF patients. This review however, shows there are sociodemographic factors that are predictive of HF readmissions in addition to the biomedical predictors that have been more extensively studied. Future studies should examine their combined effect on readmission risk and the early interventions to prevent readmissions.