Background: Heart failure (HF) has high in-hospital mortality and is associated with high readmission rates. Reasons for and ways to avoid HF readmissions are unclear. We explored readmission diagnoses and guideline adherence, as a proxy for avoidability, among patients readmitted after index hospitalization for HF.
Method: From 2008-2014, 3381 patients were referred to the BRIDGE transitional care clinic. Retrospective data was derived for 64 of the 154 HF patients who were readmitted within 30 days. Patients were assigned cohorts by readmission diagnosis: “HF or HF related,” “non-HF related other cardiac,” or “non-cardiac, non-HF related.” Patient and provider adherence to ACCF/AHA HF guidelines, including sodium and fluid restrictions, weight monitoring, outpatient follow-up, and medication, were assessed to determine readmission avoidability.
Results: Data were collected for 64 pts of whom 62 had complete data. The mean age was 70.3±10.3 years; the majority were male (n=40, 64.5%) and white (n=54, 87.1%). HF diagnoses accounted for 58.1% (n=36) of readmissions; 19.4% (n=12) were for non-HF cardiac diagnoses and 22.6% (n=14) were for non-cardiac diagnoses. Overall provider guideline adherence at discharge was high (82.3%). Providers frequently documented providing education on sodium (77.4%) and fluid restrictions (54.8%), as well as daily weights (88.7%). Patients reported compliance with sodium (94.2%) and fluid restrictions (89.2%), daily weights (96.5%), and medications (96.7%). Patients readmitted for HF had lower guideline adherence than non-HF cardiac or non-cardiac diagnoses for both provider (n=26, 72.7%; p=.046) and patient (n=28, 77.8%, p=.248). HF was also the most frequent readmission diagnoses when provider guidelines were not adhered (n=10, 90.9%).
Conclusion: Over 40% of HF readmissions within 30 days of discharge were non-HF related, half of which were also non-cardiac. Overall adherence to guidelines for both patients and providers was high, suggesting that many readmissions post-index hospitalization for HF may be unavoidable. When guidelines were not adhered to, patients were more likely to be readmitted for HF related diagnoses. Further research is needed to discern whether further reductions in readmission rates can be achieved through improved guideline adherence.