Background: This study aimed to investigate the occurrence and characteristics of unplanned 30-day readmissions after an index hospitalization for heart failure in elderly patients. We also sought to identify factors that predict readmission.
Methods: We analyzed the 2020 NRD, and non-elective hospitalizations for heart failure among elderly patients aged > 65 years were identified using ICD-10-CM. We excluded hospitalizations for younger adults and planned or elective readmissions. To compare baseline characteristics between readmissions and index hospitalizations, Pearson χ2 tests were employed. We utilized multivariate Cox regression analyses to identify independent predictors of readmissions.
Results: A total of 45,226 elderly patients were hospitalized for index admission for heart failure, 43,025 of these patients were discharged alive and 9345 were readmitted. The 30-day all-cause readmission rate was 18.9% while the specific heart failure readmission rate was 2.9%. The mortality rate in index admission was 4.8% and 9.4% in readmitted patients. The mean age of index admission was 78.6 years vs 77.5 years in readmission, about 49.2% were female in index admission vs 48.1% females in readmission cohorts. The most common reasons for readmission were sepsis, acute on chronic congestive heart failure, acute kidney injury, pneumonia, COVID-19, acute on chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, and nonrheumatic aortic stenosis. The readmission cohorts had more co-morbidities as well as in-hospital events. Readmission had a longer length of hospital stay (6.4 days vs 5.5 days, p< 0.001), and more total hospital charge (US$76,098 vs US$54,200 P =0.000). Older age, acute renal failure, history of hypertension, atrial fibrillation, oxygen dependence, anemia, and pulmonary disease were identified as statistically significant predictors of readmissions.
Conclusions: Approximately one in five elderly patients hospitalized for heart failure were readmitted within 30 days. Understanding these predictors for readmission highlighted in this study would enable clinicians to implement preventive strategies to improve the readmission rate after heart failure hospitalization among the elderly
