The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry

Aims Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short‐term post‐discharge mortality is substantial. Methods and results Using data from the...

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Published in:European journal of heart failure 2015-10, Vol.17 (10), p.1032-1041
Main Authors: Di Tano, Giuseppe, De Maria, Renata, Gonzini, Lucio, Aspromonte, Nadia, Di Lenarda, Andrea, Feola, Mauro, Marini, Marco, Milli, Massimo, Misuraca, Gianfranco, Mortara, Andrea, Oliva, Fabrizio, Pulignano, Giovanni, Russo, Giulia, Senni, Michele, Tavazzi, Luigi
Format: Article
Language:English
Subjects:
30-Day readmission
Acute Disease
Acute heart failure
Aged
Aged, 80 and over
Days-alive-out-of-hospital
Female
Heart Failure - epidemiology
Heart Failure - mortality
Humans
Incidence
Italy - epidemiology
Male
Middle Aged
mortality
Patient Readmission - statistics & numerical data
Prognosis
Prospective Studies
Registries
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Summary:Aims Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short‐term post‐discharge mortality is substantial. Methods and results Using data from the prospective, nationwide Registry IN‐HF Outcome, we analysed the incidence and predictors of 30‐day mortality or readmissions and associated days‐alive‐out‐of‐hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21–2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40–3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01–1.04, P = 0.002) and renin–angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35–0.77, P = 0.001) independently predicted 30‐day all‐cause mortality and/or readmission (c‐statistic = 0.695). Per cent 30‐day DAOH was lower in patients with in‐hospital inotrope use, no renin–angiotensin system inhibitors prescription at discharge, New York Heart Association III–IV class at discharge, and correlated inversely with length of stay and age. Conclusion A clinical and biohumoral profile consistent with chronic advanced heart failure and end‐organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow‐up.
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.290