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Objective: Recognize opportunities to mitigate readmissions following hospitalization for heart failure.Background: Heart failure (HF) is the leading cause of hospital readmissions, defined as hospital admissions that occur within 30 days of previous hospital discharge. The Hospital Readmission Reduction Program within the Affordable Care Act penalizes hospitals for readmission rates that surpass the national average for targeted diagnoses including HF. Southern Appalachia has higher HF readmission rates when compared to the national average, even among similar patients with matched comorbidities. These hospitals subsequently incur heavy financial penalties.Methods: Institutional review board (IRB) approved retrospective chart review study analyzing medical facilities in Southern Appalachia to determine factors contributing to higher readmission rates secondary to HF from 2014 to 2017.Results: Data from 3,555 patients’ charts were reviewed who had an index admission diagnosis of HF and were discharged between 2014 to 2017; 818 of these patients were readmitted within 30 days. Length of stay (LOS) of more than 5 days was significantly associated with an increased readmission rate (p = 0.0347), and current tobacco use was also significantly associated with an increased readmission rate (p = 0.0214). Use of angiotensin converting enzyme inhibitors (ACE-I) upon discharge was associated with a decrease in likelihood of readmission (p = 0.0014). Other medications prescribed at discharge (beta blockers, aldosterone antagonists, diuretics, antiplatelet, and statin) were not associated with affecting the readmission rate. Comorbidities including diabetes mellitus (DM), chronic renal failure (CRF), and psychiatric diagnoses were all associated with significantly increasing the readmission rate (p = 0.0468, p = 0.0061, and p = 0.0085, respectively). The discharge time of the day, day of the week, and month of the year were not associated with affecting the readmission rate. The type of payor for the medical care, the discharge location, and whether patients received a palliative medicine consult while hospitalized also did not affect the readmission rate.Conclusion: Strategies to mitigate readmission rates secondary to HF include limiting LOS to less than 5 days, providing smoking cessation education, and prescribing an ACE-I at the time of discharge. Methods to minimize development of DM and CRF through controlling contributing risk factors and ensuring appropriate management of psychiatric disorders are additional platforms for decreasing readmission rates for HF. Counter to previous assumptions, the discharge time of the day, day of the week, and month of the year did not affect the rate of readmissions, nor did the type of payor, the discharge location, or whether patients received palliative medicine consults.