Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 13, Number 4, August 2022, pages 206-217


Factors Influencing Thirty-Day Readmission Rate in Patients With Heart Failure Exacerbation

Figures

Figure 1.
Figure 1. Flowchart of data exclusions. COVID-19: coronavirus disease 2019; BNP: brain natriuretic peptide; Alb: albumin; BMI: body mass index.
Figure 2.
Figure 2. Forest plot for logistic regression for likelihood of readmission in 30 days. ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation; LOS: length of stay.
Figure 3.
Figure 3. Forest plot for logistic regression of likelihood of mortality. ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation; LOS: length of stay.
Figure 4.
Figure 4. Forest plot for logistic regression for likelihood of ICU admission. GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation; LOS: length of stay.

Tables

Table 1. Frequency Table for Entire Population
 
VariableCount%
aNot all patients had creatinine, lactate, and troponin labs. ICU: intensive care unit; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; GDMT: guideline-directed medical therapy.
Readmitted68110.90%
Female2,91746.90%
Male3,30553.10%
Black79712.80%
White5,10082.00%
Mortality4577.30%
Discharged to hospice3635.80%
Readmitted mortality426.20%
Readmitted discharged to hospice233.40%
ICU stay87514.10%
Uninsured1692.70%
X-ray within 1 day5,82093.50%
No X-ray3004.80%
Echo within 1 day3,13650.40%
No echo2,42639.00%
Mechanical ventilation2794.50%
Received beta-blockers4,19867.50%
Received ACEI/ARBs2,38338.30%
Received all GDMT1,90930.70%
Received IV fluids67110.80%
Received diuretic within 2 h1,77928.60%
Never received diuretic2,63642.40%
Cardiac diet3,88762.50%
Cardiology consulted5,36086.10%
Abnormal albumin2,67343.00%
Abnormal creatininea2,76644.50%
Abnormal troponina1,51938.80%
Abnormal lactatea49221.60%
Abnormal sodium2,49140.00%
Abnormal BNP3,65358.70%

 

Table 2. Readmission vs. No Readmission Frequency Table
 
VariableNot readmittedReadmitted
N%N%
ICU: intensive care unit; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide.
Sex
  Female2,61347.20%30444.60%
  Male2,92852.80%37755.40%
Race
  Native American20.03%00.00%
  Asian170.30%10.10%
  Black72113.00%7611.20%
  Other2734.90%324.70%
  White4,52881.70%57284.00%
Mortality
  No mortality5,09291.90%67398.80%
  Mortality4498.10%81.20%
Hospice
  No hospice5,18693.60%67398.80%
  Hospice3556.40%81.20%
ICU flag
  No ICU stay4,80086.60%54780.30%
  ICU stay74113.40%13419.70%
Insured
  Insured5,39197.30%66297.20%
  Uninsured1502.70%192.80%
X-ray
  ≤ 1 day5,19293.70%62892.20%
  > 1 day811.50%213.10%
  No X-ray2684.80%324.70%
Echo
  ≤ 1 day2,81050.70%32647.90%
  > 1 day57510.40%8512.50%
  No echo2,15638.90%27039.60%
Mechanical ventilation
  No5,30395.70%64094.00%
  Yes2384.30%416.00%
Beta-blockers
  Not received1,80732.60%21731.90%
  Received3,73467.40%46468.10%
AECI/ARBS
  Not received3,40161.40%43864.30%
  Received2,14038.60%24335.70%
GDMT
  No GDMT1,38625.00%16424.10%
  Some requirements2,43644.00%32748.00%
  All1,71931.00%19027.90%
IV fluid
  Not received4,95489.40%59787.70%
  Received58710.60%8412.30%
Time to diuretic
  ≤ 2 h1,63229.50%14721.60%
  > 2 h1,60328.90%20430.00%
  Never2,30641.60%33048.50%
Diet
  Non-cardiac2,09137.70%24435.80%
  Cardiac3,45062.30%43764.20%
Cardiac consult
  No consult77614.00%8612.60%
  Consulted4,76586.00%59587.40%
Albumin
  Normal3,18957.60%36052.90%
  Abnormal2,35242.40%32147.10%
Creatinine*
  Normal3,07455.50%38256.10%
  Abnormal2,46744.50%29943.90%
Troponin*
  Normal2,13561.00%26663.60%
  Abnormal1,36739.00%15236.40%
Lactate*
  Normal1,59978.90%18874.30%
  Abnormal42721.10%6525.70%
Sodium*
  Normal3,34760.40%38456.40%
  Abnormal2,19439.60%29743.60%
BNP
  Normal2,25940.80%31045.50%
  Abnormal3,28259.20%37154.50%

 

Table 3. Logistic Regression for Likelihood of Readmission in 30 Days
 
FactorOdds ratio95% CIP value
CI: confidence interval; LOS: length of stay; ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation; BP: blood pressure.
LOS1.0261.006, 1.0470.013
Age0.9860.979, 0.993< 0.001
Sex1.0880.921, 1.2850.32
Race (other)0.8750.599, 1.2770.487
Race (black)0.7810.597, 1.0210.07
Diuretic time > 2 h1.291.018, 1.6340.035
Diuretic time, never1.5551.237, 1.955< 0.001
Elixhauser1.0440.996, 1.0930.072
GDMT0.7810.647, 0.9440.011
IV fluid0.9210.704, 1.2050.55
Insured0.8510.51, 1.4190.536
Diet1.1550.952, 1.4020.144
Cardiac consult1.0670.792, 1.4370.67
ICU flag1.6651.274, 2.178< 0.001
Vent1.2670.816, 1.9680.292
X-ray ≤ 1 day0.8810.646, 1.2030.426
Echo ≤ 1 day0.8360.700, 0.9980.047
Max respiratory rate0.9940.984, 1.0040.258
Min SpO21.0110.995, 1.0270.192
Min pulse0.9920.985, 0.99990.046
Max systolic BP1.0010.998, 1.00040.629
Abnormal albumin1.1190.924, 1.3540.25
Abnormal creatinine0.9120.764, 1.0900.313
Abnormal sodium1.1160.935, 1.3310.224
Abnormal BNP0.9660.802, 1.1640.717

 

Table 4. Logistic Regression for Likelihood of Mortality
 
FactorOdds ratio95% CIP value
CI: confidence interval; LOS: length of stay; ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation.
LOS0.9170.892, 0.942< 0.001
Age1.0531.04, 1.065< 0.001
Sex0.9880.792, 1.2330.915
Race (other)0.5020.271, 0.9280.028
Race (black)0.6880.447, 1.0580.089
Diuretic > 2 h1.0440.795, 1.3720.755
No diuretic0.680.504, 0.9180.012
Elixhauser1.2671.196, 1.342< 0.001
GDMT0.5180.394, 0.682< 0.001
IV fluid0.8140.592, 1.1180.204
Insured0.4980.123, 2.0220.329
Cardiac diet0.6320.502, 0.797< 0.001
Cardiac consult1.8281.131, 2.9530.014
ICU flag2.1271.583, 2.858< 0.001
Vent4.893.314, 7.215< 0.001
X-ray ≤ 1 day1.1830.713, 1.9620.515
Echo ≤ 1 day0.6060.483, 0.759< 0.001
Max respiratory1.0251.015, 1.035< 0.001
Min SpO20.9580.944, 0.972< 0.001
Min pulse1.0121.003, 1.0220.01
Max systolic0.9960.991, 10.043
Abnormal albumin1.6511.276, 2.136< 0.001
Abnormal creatinine1.6881.330, 2.143< 0.001
Abnormal sodium1.4731.172, 1.852< 0.001
Abnormal BNP2.2681.687, 3.05< 0.001

 

Table 5. Logistic Regression for Likelihood of ICU Admission in Their Initial Presentation
 
VariableOdds ratio95% CIP value
CI: confidence interval; ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation.
Readmit1.6281.284, 2.065< 0.001
Age0.9880.981, 0.995< 0.001
Sex1.1790.997, 1.3950.054
Race (other)1.1170.775, 1.6080.554
Race (black)0.5610.416, 0.758< 0.001
GDMT0.9350.778, 1.1220.47
Diuretic > 2 h1.7031.378, 2.103< 0.001
Diuretic time, never1.2590.997, 1.5900.053
Elixhauser1.0891.042, 1.138< 0.001
IV fluid2.3061.860, 2.860< 0.001
Cardiac consult1.7021.152, 2.5150.008
Cardiac diet0.7260.607, 0.869< 0.001
X-ray ≤ 1 day1.2170.840, 1.7630.299
Echo ≤ 1 day1.8651.562, 2.227< 0.001
Max respiratory1.0551.047, 1.063< 0.001
Min SpO20.9910.979, 1.0030.135
Min pulse1.0020.995, 1.0090.557
Max systolic1.0041.000, 1.0070.025
Abnormal albumin2.9642.448, 3.589< 0.001
Abnormal creatinine1.140.956, 1.3600.145
Abnormal sodium1.5771.331, 1.868< 0.001
Abnormal BNP1.4161.164, 1.723< 0.001

 

Table 6. Linear Regression for ICU Length of Stay
 
FactorUnstandardized coefficientsStandardized coefficient95% CI for BP value
BStandard errorβ
CI: confidence interval; ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation.
(Constant)1.5722.332-3.004, 6.1490.5
Readmit-0.1450.366-0.012-0.864, 0.5730.692
Age-0.0070.011-0.019-0.029, 0.0150.555
Sex0.5540.2690.0640.026, 1.0810.04
Race (other)-0.1080.579-0.006-1.245, 1.0280.852
Race (black)-0.2580.497-0.016-1.233, 0.7180.604
GDMT0.550.2930.06-0.025, 1.1260.061
Diuretic > 2 h1.0470.3480.1230.365, 1.7290.003
Diuretic time, never-0.370.392-0.04-1.138, 0.3990.346
Elixhauser0.0160.0690.008-0.119, 0.1510.813
IV fluid1.7170.3120.1771.104, 2.330< 0.001
Cardiac consult-0.6990.657-0.033-1.988, 0.5900.287
Diet-0.1960.279-0.023-0.744, 0.3520.483
X-ray ≤ 1 day-0.3220.611-0.016-1.520, 0.8770.599
Echo ≤ 1 day-0.0830.276-0.009-0.625, 0.4590.763
Max respiratory0.0510.0110.1550.029, 0.072< 0.001
Min SpO2-0.0170.017-0.035-0.049, 0.0160.312
Min pulse-0.0160.011-0.049-0.037, 0.0050.129
Max systolic0.0050.0050.035-0.004, 0.0150.293
Abnormal albumin1.1210.3330.1120.467, 1.774< 0.001
Abnormal creatinine0.6460.2870.0740.084, 1.2090.024
Abnormal sodium1.0980.2810.1250.546, 1.650< 0.001
Abnormal BNP0.440.3170.045-0.182, 1.0610.166