Abstract 3801: Readmission for Heart Failure: 15 vs 30 Days
Background: Readmission within 30 days of discharge following hospitalization for heart failure (HF) is a target for a major imitative to reduce healthcare cost targeting primarily acute care hospitals. It has been speculated that readmission within 15 days particularly reflects suboptimal in-patient care.
Methods: Prospective study of consecutive patients hospitalized following discharge of hospitalization for HF. All patients were interviewed and a standardized detailed questionnaire was administered that covered extensive information related to prior hospitalization including compliance with core measures, social status, filling out prescriptions and out patient follow up with health care providers. We interviewed 50 consecutive patients who were readmitted within 30 days, Group 1 included 32 (64%) who were readmitted within 15 days (Mean 6.6±4.4 days). Compared to patients (Group 2) who were readmitted 16 to 30 days after discharge (18 patients, mean 22.6±3.9 days), patients in Group (1) were more likely to have lower EF (33.9±20 vs. 46.3±17, p=0.038), higher E/E′ ratio on echocardiogram (21.58±5.16 vs. 15.00±4.03, p=0.004), lower respiratory rate on discharge (18.28±1.78 vs. 19.61±1.85, p=0.016), received lower total daily metoprolol dose on discharge (71.9±56vs 137.5±58, p=0.037) and higher level of hemoglobin (11.7±2.2 vs. 10.1±2.3, p=0.016) and hematocrit (36.9±6.4 vs. 32.0±7.2, p=0.017) on admission. 84% of Group (1) didn’t follow up with primary care provider after discharge compared to 44% of Group (2) (p=0.043). Medication noncompliance and dietary noncompliance were 34.3% and 15.6% in Group (1) compared to 33.3% and 22.2% in Group (2).
Non compliance with medications and diet is a major cause of readmission within 15 and 30 days of discharge.
Contrary to common belief, lack of follow up with health care providers - a factor beyond hospital control - occurred significantly more in patients readmitted within 15 compared to 30 days.
Coordinating out patient follow up upon discharge should be considered as one of key measures in preventing readmission.