Abstract 19999: A Drop in Admission Serum Creatinine is Prognostically Similar to a Rise in Admission Serum Creatinine in Hospitalized Medicare Beneficiaries with Heart Failure: Impact on 30-Day All-Cause Readmission
Background: Heart failure (HF) is the leading cause for 30-day all-cause hospital readmission, which is targeted in the Affordable Care Act for Medicare cost reduction. Kidney function plays an important role in the pathophysiology and prognosis of HF. The objective of this analysis was to test the hypothesis that changes in admission serum creatinine (sCr) is associated with readmission in HF patients.
Methods: Of the 8049 Medicare beneficiaries discharged alive from 106 U.S. hospitals during 1998-2001, data on admission, discharge, and highest sCr were available from 6854 patients. A rise in admission sCr by ≥0.3 mg/dL (acute kidney injury or AKI), occurred in 2179 (32%) patients and a drop in admission sCr by ≥0.3 mg/dL (reverse AKI) occurred in 789 (12%) patients. Patients with changes <0.3 mg/dL in admission sCr were used as reference (n=3886). Hazard ratios (HR) and 95% CIs for 30-day all-cause readmission associated with a rise and drop in sCr were estimated using multivariable (MV) Cox regression models adjusting for 41 baseline characteristics.
Results: Participants had a mean (±SD) age of 76 (±11) years, 58% were women, and 25% were African American. Unadjusted 30-day all-cause readmission occurred in 24%, 25% and 19% of those in the rise, drop, and reference groups, respectively. Compared to reference group, MV-adjusted HRs (95% CIs) for 30-day all-cause readmission for those with a rise (AKI) and drop (reverse AKI) in sCr were 1.16 (1.03-1.31) and 1.20 (1.02-1.41), respectively.
Conclusions: Among hospitalized older HF patients, a rise or drop in admission sCr ≥0.3 mg/dL has independent association with higher 30-day all-cause readmission. Future studies need to develop and test interventions to improve outcomes in these high-risk subsets of HF patients.
Author Disclosures: M. Siddiqui: None. P.W. Sanders: None. G. Arora: None. C.J. Morgan: None. S.D. Prabhu: Research Grant; Significant; NIH and VA grants. A. Agarwal: None. D.A. Calhoun: None. G.R. Cutter: None. R.L. Mehta: None. P. Deedwania: None. G.C. Fonarow: None. W.S. Aronow: None. R. Kheirbek: None. R. Fletcher: None. R.M. Allman: None. A. Ahmed: None.
- © 2014 by American Heart Association, Inc.