Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials.

Published

Journal Article

Readmission or death after heart failure (HF) hospitalization is a consequential and closely scrutinized outcome, but risk factors may vary by population. We characterized the risk factors for post-discharge readmission/death in subjects treated for acute heart failure (AHF).A post hoc analysis was performed on data from 744 subjects enrolled in 3 AHF trials conducted within the Heart Failure Network (HFN): Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE-AHF), Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF). All-cause readmission/death occurred in 26% and 38% of subjects within 30 and 60 days of discharge, respectively. Non-HF cardiovascular causes of readmission were more common in the ≤30-day timeframe than in the 31-60-day timeframe (23% vs 10%, P = .016). In a Cox proportional hazards model adjusting a priori for left ventricular ejection fraction <50% and trial, the risk factors for all-cause readmission/death included: elevated baseline blood urea nitrogen, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) non-use, lower baseline sodium, non-white race, elevated baseline bicarbonate, lower systolic blood pressure at discharge or day 7, depression, increased length of stay, and male sex.In an AHF population with prominent congestion and prevalent renal dysfunction, early readmissions were more likely to be due to non-HF cardiovascular causes compared with later readmissions. The association between use of ACEI/ARB and lower all-cause readmission/death in Cox proportional hazards model suggests a role for these drugs to improve post-discharge outcomes in AHF.

Full Text

Duke Authors

Cited Authors

  • Vader, JM; LaRue, SJ; Stevens, SR; Mentz, RJ; DeVore, AD; Lala, A; Groarke, JD; AbouEzzeddine, OF; Dunlay, SM; Grodin, JL; Dávila-Román, VG; de Las Fuentes, L

Published Date

  • November 2016

Published In

Volume / Issue

  • 22 / 11

Start / End Page

  • 875 - 883

PubMed ID

  • 27133201

Pubmed Central ID

  • 27133201

Electronic International Standard Serial Number (EISSN)

  • 1532-8414

International Standard Serial Number (ISSN)

  • 1071-9164

Digital Object Identifier (DOI)

  • 10.1016/j.cardfail.2016.04.014

Language

  • eng