Background: Decompensated Heart failure (HF) is one of the many challenges of the US healthcare system. 12 to 27% at 30-day is the readmission rate for this condition, resulting in decreased quality of life and increased cost of care. 2017 Heart Failure guidelines have recommended a pre-discharge pro-Brain Natriuretic Peptide (ProBNP) to establish post-discharge prognosis in patients with HF decompensation. We designed a study to evaluate the role of percentage change in ProBNP from admission to discharge and associated co-morbidities, for patients admitted with decompensated HF and correlate it with 30-day readmission. (1) (2)
Methods: Prospective pilot study of patients admitted with decompensated HF. Patients < 18 years, pregnant, AMI, severe valvular disease, pericardial disease, myocarditis, cardioverted, chemotherapy, sepsis, and burns were excluded. Patients had ProBNP measured on admission and discharge. All patients were evaluated and treated as per CHF guidelines. They were discharged at the primary team’s discretion when deemed clinically appropriate. Patients received post discharge call after 30 days, to evaluate compliance with medications, PCP/cardiology follow-up, ED visits and readmission.
Results: One hundred and twenty-five patients were included in analysis. The 30-day readmission rate was 22.4% (28/125). The average age of the readmission was 71 ± 11.9 years, with Male sex as majority 64.3% (18/28) and Hispanic 64.3% (18/28) as ethnic group predominance. All patient readmitted had HTN, while 43% (12/28) had DM and 46% (13/28) had CAD. In the subgroup, 57% had CKD 3-5. The average Charlson Comorbidity Index for the cohort was 6.8. HFrEF presented in 60% (17/28) while 32% (9/28) had HFpEF. Average LOS was 3.6 ± 2.8 days. Readmission cohort had 50% (14/28) patient with average 30% decrease in ProBNP and 50% (14/28) with average 108% increase in ProBNP. From 97 people not readmitted, 71/97 (73.2%) had decrease BNP. An average of 38 ± 22.6 % decrease in Pro-BNP between admission and discharge was seen in our study in patient who were not readmitted to the hospital and those readmitted (p=0.021). The likelihood of readmission in patients with increase in ProBNP at discharge is 2.73 CI 95 [1.15-6.50] (p=0.023) compare with the decrease ProBNP group. HTN was seen in 94.8% (92/97), while 55.6% (54/97) had DM, 22.6% (22/97) had CAD and 26.8 % (26/97) had CKD stage > 3. The average Charlson Comorbidity Index for the non-readmitted group was 5.7. HFrEF presented in 54.6% (53/97) while 40.2% (39/97) had HFpEF. Average LOS was 3.6 ± 3.1 days. The interquartile range (IQR) for percentage change in ProBNP in overall cohort was -43.9% to 16.2% (Q1-Q3), with readmission cohort being -27.4% to 58.2% and non-readmission group being -44.5% to 4.99%. The 30-day telephone follow-up of readmitted patients, from the 28 readmitted showed that18/19 were complaint with meds, 47 % follow up with PCP and 26% had cardiology follow up.
Conclusions: Our data supports the value of change in ProBNP to predict 30-day readmission among patients discharged with CHF decompensation. Patient with decompensated Heart Failure have a 2.73 increase risk of being readmitted if they have an increase in ProBNP at discharge compare to those with decrease ProBNP. We believe that an achievement of 38% or more of BNP reduction should be seen at patient’s discharge, to prevent readmission. Ensuring compliance with guidelines, among all treating physicians, remains the cornerstone for managing these complex patients with Heart Failure.