Abstract 13331: Predictors of 30-Day Readmission Among Commercially Insured and Medicaid-Enrolled Patients Hospitalized with Systolic Heart Failure
Background: Existing risk models for readmission following hospitalization for heart failure (HF) have been derived primarily from randomized trial populations or data on Medicare enrollees. Our objective was to assess factors associated with 30-day readmission rates for commercially insured and Medicaid-enrolled beneficiaries with an index admission for systolic HF.
Methods: We evaluated the first hospitalization with a diagnosis of systolic HF (per ICD-9 code) during the period 1/1/2005-6/30/2009 for patients in the MarketScan® Commercial and Medicaid Databases discharged alive with ≥12 months continuous medical and pharmacy eligibility before the admission date and ≥30 days after the discharge date. Patients with a HF hospitalization in the pre-period or heart transplant were excluded. Stepwise logistic regression was used to identify significant readmission risk factors from among patient demographics, comorbid conditions, and inpatient procedures received during the index admission.
Results: Among 5,234 unique systolic HF index admissions (mean age 57 years), 30-day readmission rates were 12.1% (95% CI: 11.2-13.0%) for all causes and 4.3% (95% CI: 3.8%-4.9%) for HF. Significant independent predictors of 30-day all-cause readmission are below (Table 1). Factors associated with increased odds of 30-day HF-related readmissions were Medicaid payer (vs. commercially insured; OR 1.37), renal failure (OR 1.50), and decubitus ulcer (OR 1.90) (model results not shown).
Conclusion: Patient severity of illness, reflected in major comorbidity and length of stay, is a primary predictor of all-cause readmission. Additionally, in commercially insured and Medicaid-enrolled populations, younger patients hospitalized with HF are at higher risk of all-cause readmission, although the effect size is small.
- © 2011 by American Heart Association, Inc.