Abstract 302: Factors Influencing Heart Failure Readmissions at the Jesse Brown Veterans Administration Hospital
Background: Heart failure (HF) hospitalizations and readmissions are a major financial burden on patients, caregivers, and the healthcare system. The Jesse Brown Veterans Administration Medical Center (JBVAMC; Chicago, Illinois) has recently been scoring in the 90th percentile in its HF risk-standardized readmission rate (RSRR) compared to other VA medical centers. Here, we present the factors influencing HF readmission at the JBVAMC.
Methods: Veterans discharged from JBVAMC between 7/1/18 and 6/30/19 with a primary diagnosis of HF were identified per ICD-10 codes (I11.0, I13.X, and I50.X). For primary HF discharges between 7/1/18 and 12/31/18, retrospective chart review was performed to assess patient and hospitalization characteristics. Charts were excluded from review if the same veteran’s chart was reviewed for another admission within the preceding 30 days, or if a veteran was discharged against medical advice or to a skilled nursing facility. Continuous variables were analyzed using Student’s t-test and categorical variables with Pearson Chi-Square.
Results: Between 7/1/18 and 6/30/19, there were 485 HF discharges resulting in 96 30-day readmissions. Of them, 51 (53%) were due to recurrent HF exacerbation, and 8 (8%) were due to hypotension, dehydration, or acute kidney injury. Only 32% of readmissions (8/25) during the first 7 days after discharge were due to recurrent HF, compared to 70% (19/27) during day 8-14 and 57% (13/23) during day 15-21. In characterizing the index hospitalizations between 7/1/18 and 12/31/18 (N=188), there were 42 (22%) admissions that resulted in readmissions (Table 1). Veterans in this cohort were 72 years old on average, 98% male, and 77% African-American. HF with reduced ejection fraction (HFrEF; EF≤40%) comprised 53% of non-readmitted and 57% of readmitted cohort. Readmitted patients had a higher prevalence of smoking (33% vs 16%, p=0.012) and less likely to have outpatient follow-up within 14 days of discharge (52% vs 29%, p=0.007). There was a low rate of sacubitril/valsartan utilization (N=6) and dietitian consultation (N=7).
Conclusion: Over half of our HF readmissions are due to recurrent HF. An emphasis on timely outpatient follow-up after discharge, consideration for sacubitril/valsartan initiation, and dietary education may help reduce our HF readmissions.
