The Identification of Patient and Process Characteristics Associated with 30-day Heart Failure Readmissions at an Academic Medical Center: A Retrospective Analysis

From the 2019 HVPAA National Conference

Dr. Michael Belmont (Loyola University Medical Center), Dr. Kevin Smith (Loyola University Medical Center)

Background

Readmission rate for decompensated heart failure hospitalization is a core quality metric. Recently, Loyola University Medical Center (LUMC) in Maywood, IL has experienced readmission rates up to 25%, resulting in potentially avoidable dangerous experiences for patients.

Objectives

To identify differences in patient characteristics and process measures between patients who experience 30-day heart failure readmissions and those that do not at LUMC.

Methods

372 index admissions between January, 2017 to an end date in October, 2017 primarily for decompensated heart failure amongst patients age 18 years or older with no history of advanced heart failure therapies were identified using standard quality-tracking methods and analyzed. Total 30-day readmission rates, 30-day readmission rates for recurrent decompensated heart failure, and all-cause mortality at index admission were collected, while patient and process characteristics were compared using two sample difference of means t-tests as below.

Results

76 of the 372 index admissions resulted in 30-day readmissions, of which 30 were unrelated to recurrent decompensated heart failure, and 46 were due to recurrent decompensated heart failure.

Of the non-heart failure readmissions, by far the largest category of causes was bleeding events (9 out of 30). Only 2 patients were re-admitted due to complications from over-diuresis. Of the 46 recurrent decompensated heart failure readmissions, 19 were “uncomplicated” in that they did not involve another significant pathologic process, and patients were not in the end stages of any pathologic process. Of the 27 “complicated” recurrent decompensated heart failure readmissions, 17 were identified as having end-stage heart failure.

There was no statistical difference in two-sample difference of means t-testing between re-admitted and non-readmitted patients (excluding patient deaths during index admission, of which there were 16) in age (69 readmitted vs 70 non-readmitted, P = 0.65), most recent EF at index admission (35% vs 37%, P = 0.24) , proportion of English-speakers (87% vs 92%, P = 0.25) , involvement of a cardiologist in the index admission (71% vs 62%, P = 0.12), overall follow-up within 14 days of discharge (50% vs 58%, P = 0.23) , follow up with a PCP (26% vs 32%, P = 0.37), and follow-up with a heart failure nurse practitioner (22% vs 24%, P = 0.71) . There were significant differences in length of stay (7.9 days vs 6.2 days, P = 0.03), follow-up with a cardiologist (9% vs 20%, P = 0.008), follow-up with two or more providers (8% vs 17%, P = 0.02), and Charlson Comorbidity Index (7.7 vs 6.8, P = 0.017). Regression analysis is pending.

Conclusions

Readmission for recurrent decompensated heart failure amongst both “uncomplicated” and end-stage heart failure patients offer opportunities for systemic improvement at LUMC. Demographic and process measures are mostly similar between re-admitted and non-readmitted patients, with higher baseline morbidity amongst re-admitted patients. Readmission for over-diuresis is relatively rare at LUMC.

Clinical Implications

Prior to this study, no large-scale study of heart failure readmissions at LUMC had been performed. The results provide insight into the causes of heart failure readmissions at LUMC, and will help guide ongoing efforts to reduce the readmission rate.

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