Abstract 3798: Impact of Worsening Renal Function During Hospitalization for Heart Failure on 30 Day Outcomes Among Medicare Beneficiaries in OPTIMIZE-HF
Background: While baseline renal disease is common in heart failure (HF), the impact of worsening renal function (WRF) on outcomes following hospitalization for HF is poorly understood.
Methods: OPTIMIZE-HF registry records were linked to Medicare claims to identify Medicare beneficiaries (≥65 years) admitted with HF in 2003– 4 at 259 participating hospitals. We included a total of 20,063 fee-for-service patients living in the US, who were alive at index hospitalization discharge, had no history of dialysis and non-missing creatinine values. WRF was defined as a change in serum creatinine ≥0.3 mg/dL from admission to discharge during the index hospitalization. 30 day total inpatient costs, readmission and mortality endpoints were extracted from Medicare claims files. The relationships between WRF and these outcomes were assessed using generalized models with a log link and Poisson distribution for inpatient costs, Kaplan Meier methods for mortality rates, cumulative incidence function for readmission rates and multivariable Cox proportional hazards models with robust standard errors for mortality and readmission.
Results: WRF was common (n=3,581;17.8%) and more likely to be present among those with greater comorbid conditions and lower baseline renal function. In addition, WRF was associated with similar 30 day mean inpatient costs ($3,277 <0.3 mg/dL vs $3,255 ≥0.3 mg/dL, p-value 0.22), but higher 30 day readmission (20.6% <0.3 mg/dL vs 21.8% ≥0.3 mg/dL, p-value 0.011) and mortality rates (7.2% <0.3 mg/dL vs 10.0% ≥0.3 mg/dL, p-value <.0001). After adjustment for baseline site and patient characteristics, these differences for readmission and mortality rates persisted (Table⇓).
Conclusions: WRF during a HF hospitalization remains an important and independent predictor for short-term readmission and mortality. These findings highlight the importance of assessing change in renal function to identify patients at high risk for early morbidity and mortality.