HF Readmission More Likely in HF With Reduced Than With Preserved EF

April 17, 2018

The risk for readmission with acute decompensated heart failure (ADHF) is about 40% higher after a hospitalization with heart failure (HF) with reduced ejection fraction (HFrEF) than with preserved ejection fraction (HFpEF), suggests an observational study.

Patients with HFrEF in the analysis, based on an Atherosclerosis Risk in Communities (ARIC) cohort, were also more likely to have multiple readmissions for ADHF, report investigators in a study published online March 28 in the American Journal of Cardiology.

The analysis looked at all ADHF readmissions once patients were discharged from an HF hospitalization, in contrast to many HF studies that stop at the first rehospitalization event, observed lead author, Melissa C Caughey, PhD, University of North Carolina, Chapel Hill.

"Most of the patients had only a single readmission, but some had as many as eight readmissions in 1 year of follow-up," she told theheart.org | Medscape Cardiology. Counting more than just a first readmission, she said, provides a more complete view total ADHF burden after an HF discharge.

Unlike ADHF readmission, mortality throughout the 1 year of follow-up was similar for patients with HFrEF and HFpEF, the groups defined by left ventricular ejection fraction (LVEF) of less than 50% and 50% or greater, respectively.

Of note, given that the LVEF threshold for separating HFrEF from HFpEF varies in the literature, Caughey and her colleagues also conducted the ADHF-rehospitalization analysis using cut points of 55% and 45%, finding similar 1-year risk increases for HFrEF.

The main analysis included 1133 patients discharged from an ADHF hospitalization with documented LVEF from 2005 to 2014.

The 573 patients with HFpEF were significantly more likely to be women (63% vs 44% for HFrEF), to be obese (43% vs 27%), and to have chronic obstructive pulmonary disease (34% vs 27%). Not surprisingly, they were significantly less likely to have a history of coronary heart disease (53% vs 63%) and myocardial infarction in particular (17% vs 29%).

Table. Adjusted Hazard Ratios for Overall ADHF Readmission in ARIC Cohort

Follow-up Time Hazard Ratio (95% CI)
30 d 1.41 (0.92 - 2.18)
90 d 1.39 (1.05 - 1.85)
6 mo 1.47 (1.18 - 1.84)
1 y 1.42 (1.18 - 1.70)

 

Patients with HFrEF were significantly more likely to be readmitted for ADHF at least once at different time points out to 1 year, with hazard ratios of approximately 40% in analyses adjusted for demographic characteristics, hypertension, comorbidities, obesity, hemoglobin, insurance status, geographic location, and year of index hospitalization.

Hospitals with a preponderance of HFrEF in their HF case mix, the authors propose, could be subject to greater reimbursement penalties based on 30-day all-cause readmissions imposed by the Centers for Medicare & Medicaid Services (CMS).

Caughey and her colleagues report that they have no relevant disclosures.

Am J Cardiol. Published online March 28, 2018. Abstract

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