PREDICTORS OF READMISSION FOR HEART FAILURE PATIENTS Pérez Belmonte, LM; Herrero García, V; Zafra Sánchez, FJ; Blanco Díaz, MJ; Platero Sánchez-Escribano, M; Medina Delgado, P; Loring Caffarena, M; Pérez Díaz, JM. Department of Internal Medicine. County Hospital of The Axarquia. Vélez-Málaga, Málaga. Spain OBJECTIVES The objective of this study was to know the clinical characteristics of admitted patients with heart failure (HF) and to determinate predictors of readmission in our department over the past 5 years. MATERIAL AND METHODS Retrospective analysis of 681 HF patients admitted between January 2007 and December 2011. Patients were divided into two groups: Readmission group (RG) and group of non-readmission (NRG). Within RG was divided in: readmission within 1 month, between 1 and 6 months, between 6 and 12 months and more than 12 months. We analyzed demographic data, clinic, echocardiography and laboratory variables. We performed a bivariate statistical analysis, comparing the qualitative variables with Chi-squared test and quantitative variables with Student’s t-test. RESULTS 265 patients (38.9%) were included in the RG, of which 15.4% were within the first month, 23.4% between 1 and 6 months, 23.4% between 6 and 12 months, and 37.8% more than 12 months. They had an average of 3 admissions (2-12). The average hospital stay of RG was higher in two days respect to another group (10 vs. 8, p<0.01). The RG was older (73.2 vs. 71.8 years old, p=0,002) and had fewer foreigners (8.7 vs. 17.5%, p=0.001). However, there were no gender differences with a male/female percentage 60/40. In the RG were more frequent high blood pressure (HBP) (86.8 vs. 74.8%, p<0.0001), diabetes mellitus (DM) (54 vs. 38.2%, p<0.0001), ischemic cardiomyopathy (ICM) (49 vs. 46%, p<0,05), atrial fibrillation (AF) (45.7 vs. 36.3%, p<0,05), chronic obstructive pulmonary disease (COPD) (26.4 vs. 19.2%, p=0.01), anemia (47.9 vs. 33.7%, p<0,001) and chronic kidney failure (CKF) (36.2 vs. 21.4%, p<0.0001). Readmitted patients had higher hospital mortality (11.3 vs. 3.1%, p<0.0001) and worse functional class, 61.1% with NYHA 3 or more compared to 36.8% of NRG. RG
NRG
p
10 Hospital stay (days)
8
<0.01
Age (years 73.2 old)
71.8
0.002
Foreigners 8.7 (%)
17.5
0.001
HBP (%)
86.8
74.8
<0.0001
DM (%)
54
38.2
<0.0001
ICM (%)
49
46
<0.05
AF (%)
45.7
36.3
<0.05
COPD (%)
26.4
19.2
0.01
Anemia (%)
47.9
33.7
<0.001
CKF (%)
36.3
21.4
<0.0001
Hospital mortality (%)
11.3
3.1
<0.0001
NYHA 3-4 (%)
61.1
36.8
<0.0001
38.9%
61.1%
RG NRG
40
35
<1 month 1-6 months 6-7 months >12 months
30
25
20
15
10
5
0 RG
DISCUSSION Heart failure is the leading cause of hospitalization and readmission in many hospitals world-wide. It is associated with an important morbid-mortality. Variables like HBP, DM, ICM, AF, COPD, anemia and CKF are readmission’s determinants. These factors have been described in previous studies along with systolic dysfunction, although in our study is not a readmission variable, also showing that ventricular ejection fraction does not interfere much in the heart failure prognosis.
CONCLUSIONS Several clinical factors determine the morbi-mortality and prognosis including an older age, associated comorbidity and functional class. All these factors are detectable at the time of hospital admission.