Abstract P346: Racial and Ethnic Differences in 30-Day Readmission and 1-Year Mortality Among Patients Hospitalized for Heart Failure
Background: Prior outcomes research among heart failure (HF) patients has documented higher readmission rates among blacks vs. whites. However, data are limited among Hispanics and few studies have evaluated long-term outcomes by race/ethnicity. The purpose of this study was to evaluate 30-day readmission and 1-year mortality rates among a diverse group of hospitalized HF patients by race/ethnicity.
Methods: This was a 1-year prospective study of consecutively hospitalized patients with an admission diagnosis of HF who participated in a NHLBI clinical outcomes study (N=407; 52% white, 25% Hispanic, 20% black, 3% Asian; 38% female). Demographics (self-reported race/ethnicity, age, sex, health insurance), comorbidities (ischemic vs. non ischemic HF, hypertension, diabetes, renal failure/dialysis, peripheral vascular disease), discharge medications (inotrope, statin, ACE-I/ARB, beta blocker, calcium channel blocker, diuretic), readmission to the medical center, readmission diagnosis, and death were systematically obtained by hospital clinical information system, updated daily for readmissions and monthly with Social Security Death Index data. Having a paid caregiver was documented by standardized baseline survey. Multivariate logistic regression was used to evaluate associations between race/ethnicity and 1) 30-day readmission, and 2) death at 1-year, and to adjust for covariates.
Results: The overall 30-day readmission rate was 10% (n=41); more than half of readmissions were for HF (n=25). By 1-year, 23% (n=94) of patients died. Hispanics had significantly higher odds of readmission vs. whites/Asians (OR=3.2; 95%CI=1.6-6.5) and blacks (OR=3.9; 95%CI=1.4-10.8); these associations retained significance after adjustment (OR=3.1; 95%CI=1.4-6.9, OR=3.6; 95%CI=1.2-10.3). Readmission at 30-days did not vary between blacks and whites/Asians. Other significant predictors of 30-day readmission were diabetes (OR=2.2; 95%CI=1.1-4.1) and paid caregiving (OR=2.0; 95%CI=1.03-3.9). Odds of death at 1-year were lower among Hispanics vs. whites/Asians (OR=0.5; 95%CI=0.3-0.9); this association did not retain statistical significance after adjustment for covariates including age, paid caregiving, and medications (OR=0.6; 95%CI=0.3-1.1). Odds of death at 1-year did not differ between Hispanics and blacks, or between blacks and whites/Asians. Age >65 years and paid caregiving were associated with higher 1-year mortality (OR=2.1; 95%CI=1.3-3.3, OR=1.9; 95%CI=1.7-3.1). ACE-I/ARB, beta blocker, or calcium channel blocker prescription was associated with lower odds of death at 1-year (p<0.05).
Conclusion: Hispanics hospitalized with HF had higher odds of 30-day readmission vs. others, not explained by measured covariates. In contrast, the lower mortality at 1-year observed among Hispanics did not retain statistical significance after covariate adjustment.
Author Disclosures: H. Mochari-Greenberger: None. L.P. Cohen: None. M. Liao: None. L. Mosca: None.
- © 2015 by American Heart Association, Inc.