Aetiology, timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND-HF

Abstract

Aims: Patients hospitalized for heart failure (HF) are at high risk for 30-day readmission. This study sought to examine the timings and causes of readmission within 30 days of an HF hospitalization.

Methods and results: Timing and cause of readmission in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial were assessed. Early and late readmissions were defined as admissions occurring within 0-7 days and 8-30 days post-discharge, respectively. Patients who died in hospital or remained hospitalized at day 30 post-randomization were excluded. Patients were compared by timing and cause of readmission. Logistic and Cox proportional hazards regression analyses were used to identify independent risk factors for early vs. late readmission and associations with 180-day outcomes. Of the 6584 patients (92%) in the ASCEND-HF population included in this analysis, 751 patients (11%) were readmitted within 30 days for any cause. Overall, 54% of readmissions were for non-HF causes. The median time to rehospitalization was 11 days (interquartile range: 6-18 days) and 33% of rehospitalizations occurred by day 7. Rehospitalization within 30 days was independently associated with increased risk for 180-day all-cause death [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.93-2.94; P < 0.001]. Risk for 180-day all-cause death did not differ according to early vs. late readmission (HR 0.99, 95% CI 0.67-1.45; P = 0.94).

Conclusions: In this hospitalized HF trial population, a significant majority of 30-day readmissions were for non-HF causes and one-third of readmissions occurred in the first 7 days. Early and late readmissions within the 30-day timeframe were associated with similarly increased risk for death. Continued efforts to optimize multidisciplinary transitional care are warranted to improve rates of early readmission.

Keywords: Acute heart failure; Cause of readmission; Timing of readmission.

Conflict of interest statement

Conflict of interest: M.F. has received remuneration from Axon Therapies, Coridea, Cibiem and GE Healthcare, and is supported by an American Heart Association grant (17MCPRP33460225) and a National Heart, Lung and Blood Institute (NHLBI) T32 post-doctoral training grant (5T32HL007101-42). C.M.O’C. has received remuneration from Amgen, Astellas, GE Health-care, Gilead, Novella, Otsuka, Roche Diagnostics and Resmed. P.W.A. has received remuneration from Merck, MAST Therapeutics, AstraZeneca, Bayer, Merck and Sanofi-Aventis. J.A.E. has received remuneration from Abbott Labs, Amgen, Johnson & Johnson, Pfizer and Servier. S.J.G. is supported by an NHLBI T32 post-doctoral training grant (5T32HL069749-14). M.M. has received remuneration from Bayer, Novartis and Servier. R.C.S. has received remuneration from BioControl, Biotronik, Cardiomems, Medtronic, Novartis, the National Institutes of Health, OnoPharma and Thoratec. A.A.V. has received remuneration from Amgen, Bayer, Boehringer Ingelheim, Merck, Novartis and Servier. A.F.H. has received remuneration from Sanofi, Johnson & Johnson, AstraZeneca and Corthera. G.M.F. has received remuneration from Amgen, Bristol Myers Squibb, GSK, Medtronic, MyoKardia, Novartis, Stealth, Trevena, Amgen, Otsuka and Roche Diagnostics. R.J.M. has received remuneration from Amgen, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Novartis, Otsuka, ResMed and Thoratec. All other authors report no disclosures.

© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Figures

Figure 1

Adjudicated and investigator-reported causes of rehospitalization after heart failure (HF)-related hospitalization stratified by HF and non-HF causes. Non-HF causes are further stratified by cardiovascular (CV) and non-CV causes.

Figure 2

Timing of rehospitalization for heart failure (HF) and non-HF-related rehospitalization.

Figure 3

Time to rehospitalization by left ventricular ejection fraction (