Introduction: High risk for readmission in heart failure (HF) patients is associated with Hispanic ethnicity, multi-morbidity, and hospitals serving low socioeconomic or heavily Hispanic regions or with limited cardiac services. Information for hospitals caring primarily for such high-risk patients is lacking.
Objective: To explore and describe the characteristics of patients hospitalized for acute heart failure and identify factors associated with 30-day HF readmission in a heavily Hispanic, rural, low-income community hospital near the California-Mexico border.
Methods: Retrospective chart review of all patients admitted for HF within a two-year period was used to gather patient characteristics, presentation, previous one-year emergency department (ED) and hospital visits, medical therapy, and discharge status. Univariate analyses with student t-tests, Wilcoxon rank, and chi-square analysis as appropriate were used to identify factors associated with 30-day readmission. Logistic regression was used to identify independent predictors.
Results: A total of 215 patients experienced 288 HF hospitalizations. Patients were primarily Hispanic (72%), male (58%), and obese (56%) with a mean age of 69 years, preserved ejection fraction (52%), and four or more chronic comorbid conditions (80%). In the prior 6 months, most (53%) had an ED visit and 28% had been hospitalized. The sample had high rates of hypertension (89%), diabetes (59%), hyperlipidemia (47%), renal disease (34%), and mental health disorders (18%). Median length of stay was two days and two (.9%) patients died. In the 189 patients discharged alive and with 30-day data, 69% were classified as high risk for early readmission by a commonly used clinical risk assessment metric (LACE score). Ten (5.3%) patients were readmitted for HF within 30 days. Number of ED visits in the previous six months (OR 1.5, p=.009) and atrial fibrillation at discharge (OR 5.7, p=.039) were independent predictors of 30-day HF readmission.
Conclusions: Prior ED use and atrial fibrillation predicted early HF readmission following hospital discharge. These data provide support for a clinically useful alternative to standardized risk assessment tools in heavily Hispanic, multi-morbid, low-income HF patients.