Trends in and predictors of multiple readmissions following heart failure hospitalization: A National wide analysis from the United States

Introduction

Heart Failure (HF) currently affects ∼6 million adults in the USA. HF prevalence is projected to increase significantly, and it is estimated that 8 million adults will carry this diagnosis in 2030.

Notably, hospitalizations with a principal discharge diagnosis of HF decreased from >1 million in 2006 to ≈800,000 in 2016. Despite these improvements, total HF costs are expected to increase and will approximate $ 53 billion annually by 2030 with 80% of this attributable to HF hospitalizations. The burden of readmission following initial HF hospitalization is significant; approximately a quarter of patients are readmitted within 30 days and close to 50% are readmitted within 6 months. ^, A significant proportion of these readmissions are considered potentially avoidable and 30-day readmission rate is used as a metric for quality of care by the center for Medicare and Medicaid services (CMS). It should however be noted that this time point is arbitrary, and risk of readmission persists well beyond the initial 30 days. ^, Although early studies have reported a meaningful reduction in 30-day readmission rates after the implementation of hospital readmissions reduction program, more recent studies suggest that this improvement was transitory, and readmissions have increased again. Furthermore, multiple readmissions are common in HF patients with the vast majority occurring in the 60 days following initial admission and the 60 days preceding death (palliation phase). More importantly, mortality increased progressively with each hospitalization. Therefore, multiple readmissions can be a marker for excess mortality and can lead to incremental health care costs without adding meaningful value especially in HF patients who are in the “palliation phase”. Despite this, the burden of multiple readmissions is much less studied compared to 30-day readmission. In this study we explored the burden of multiple readmissions within 90 days of index HF admission using the National readmission database.