Characteristics and Factors of 30-Day Readmissions after Hospitalization for Acute Heart Failure in China

Abstract

Background: Patients with acute heart failure (HF) are at high risk of 30-day readmission. Little is known about the characteristics and associated factors of 30-day readmissions among patients with acute HF in China. Methods: We enrolled consecutive patients hospitalized for acute HF and discharged from 52 hospitals in China from August 2016 to May 2018. We describe the rate of 30-day readmission, the time interval from discharge to readmission, and the causes of readmission. We also analyzed the factors associated with readmission risk by fitting multivariate Cox proportional hazards models. Results: We included 4875 patients with a median age of 67 years (interquartile range, 57–75), 3045 (62.5%) of whom were male. Within 30 days after discharge, 613 (12.6%) patients were readmitted for all causes, with a median from discharge to readmission of 12 (6–21) days. Most readmissions were attributed to cardiovascular causes (71.1%) and 60.0% to HF-related causes. Readmission occurred within 14 days of discharge in more than half of the patients (56.4%). Diabetes (hazard ratio [HR]: 1.25, 95% confidence interval [95% CI]: 1.06–1.50), anemia (HR: 1.26, 95% CI: 1.03–1.53), high New York Heart Association classification (HR: 1.48, 95% CI: 1.08–2.01), elevated N-terminal pro-B type natriuretic peptide (HR: 1.67, 95% CI: 1.24–2.25), and high-sensitivity cardiac troponin T (HR: 1.26, 95% CI: 1.01–1.58) were associated with increased risks of readmission. High systolic blood pressure (HR: 0.56, 95% CI: 0.38–0.81) and Kansas City Cardiomyopathy Questionnaire-12 scores (HR: 0.64, 95% CI: 0.44–0.94) were associated with decreased risk of readmission. Conclusions: In China, almost one in eight patients with acute HF were readmitted within 30 days after discharge, mainly due to cardiovascular reasons, and approximately three-fifths of the readmissions occurred in the first 14 days. Both clinical and patient-centered characteristics were associated with readmission.

Keywords

• acute heart failure
• 30-day readmission
• characteristics
• factors