| 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




Tables
| Variable | Count | % |
|---|---|---|
| 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. | ||
| Readmitted | 681 | 10.90% |
| Female | 2,917 | 46.90% |
| Male | 3,305 | 53.10% |
| Black | 797 | 12.80% |
| White | 5,100 | 82.00% |
| Mortality | 457 | 7.30% |
| Discharged to hospice | 363 | 5.80% |
| Readmitted mortality | 42 | 6.20% |
| Readmitted discharged to hospice | 23 | 3.40% |
| ICU stay | 875 | 14.10% |
| Uninsured | 169 | 2.70% |
| X-ray within 1 day | 5,820 | 93.50% |
| No X-ray | 300 | 4.80% |
| Echo within 1 day | 3,136 | 50.40% |
| No echo | 2,426 | 39.00% |
| Mechanical ventilation | 279 | 4.50% |
| Received beta-blockers | 4,198 | 67.50% |
| Received ACEI/ARBs | 2,383 | 38.30% |
| Received all GDMT | 1,909 | 30.70% |
| Received IV fluids | 671 | 10.80% |
| Received diuretic within 2 h | 1,779 | 28.60% |
| Never received diuretic | 2,636 | 42.40% |
| Cardiac diet | 3,887 | 62.50% |
| Cardiology consulted | 5,360 | 86.10% |
| Abnormal albumin | 2,673 | 43.00% |
| Abnormal creatininea | 2,766 | 44.50% |
| Abnormal troponina | 1,519 | 38.80% |
| Abnormal lactatea | 492 | 21.60% |
| Abnormal sodium | 2,491 | 40.00% |
| Abnormal BNP | 3,653 | 58.70% |
| Variable | Not readmitted | Readmitted | ||
|---|---|---|---|---|
| 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 | ||||
| Female | 2,613 | 47.20% | 304 | 44.60% |
| Male | 2,928 | 52.80% | 377 | 55.40% |
| Race | ||||
| Native American | 2 | 0.03% | 0 | 0.00% |
| Asian | 17 | 0.30% | 1 | 0.10% |
| Black | 721 | 13.00% | 76 | 11.20% |
| Other | 273 | 4.90% | 32 | 4.70% |
| White | 4,528 | 81.70% | 572 | 84.00% |
| Mortality | ||||
| No mortality | 5,092 | 91.90% | 673 | 98.80% |
| Mortality | 449 | 8.10% | 8 | 1.20% |
| Hospice | ||||
| No hospice | 5,186 | 93.60% | 673 | 98.80% |
| Hospice | 355 | 6.40% | 8 | 1.20% |
| ICU flag | ||||
| No ICU stay | 4,800 | 86.60% | 547 | 80.30% |
| ICU stay | 741 | 13.40% | 134 | 19.70% |
| Insured | ||||
| Insured | 5,391 | 97.30% | 662 | 97.20% |
| Uninsured | 150 | 2.70% | 19 | 2.80% |
| X-ray | ||||
| ≤ 1 day | 5,192 | 93.70% | 628 | 92.20% |
| > 1 day | 81 | 1.50% | 21 | 3.10% |
| No X-ray | 268 | 4.80% | 32 | 4.70% |
| Echo | ||||
| ≤ 1 day | 2,810 | 50.70% | 326 | 47.90% |
| > 1 day | 575 | 10.40% | 85 | 12.50% |
| No echo | 2,156 | 38.90% | 270 | 39.60% |
| Mechanical ventilation | ||||
| No | 5,303 | 95.70% | 640 | 94.00% |
| Yes | 238 | 4.30% | 41 | 6.00% |
| Beta-blockers | ||||
| Not received | 1,807 | 32.60% | 217 | 31.90% |
| Received | 3,734 | 67.40% | 464 | 68.10% |
| AECI/ARBS | ||||
| Not received | 3,401 | 61.40% | 438 | 64.30% |
| Received | 2,140 | 38.60% | 243 | 35.70% |
| GDMT | ||||
| No GDMT | 1,386 | 25.00% | 164 | 24.10% |
| Some requirements | 2,436 | 44.00% | 327 | 48.00% |
| All | 1,719 | 31.00% | 190 | 27.90% |
| IV fluid | ||||
| Not received | 4,954 | 89.40% | 597 | 87.70% |
| Received | 587 | 10.60% | 84 | 12.30% |
| Time to diuretic | ||||
| ≤ 2 h | 1,632 | 29.50% | 147 | 21.60% |
| > 2 h | 1,603 | 28.90% | 204 | 30.00% |
| Never | 2,306 | 41.60% | 330 | 48.50% |
| Diet | ||||
| Non-cardiac | 2,091 | 37.70% | 244 | 35.80% |
| Cardiac | 3,450 | 62.30% | 437 | 64.20% |
| Cardiac consult | ||||
| No consult | 776 | 14.00% | 86 | 12.60% |
| Consulted | 4,765 | 86.00% | 595 | 87.40% |
| Albumin | ||||
| Normal | 3,189 | 57.60% | 360 | 52.90% |
| Abnormal | 2,352 | 42.40% | 321 | 47.10% |
| Creatinine* | ||||
| Normal | 3,074 | 55.50% | 382 | 56.10% |
| Abnormal | 2,467 | 44.50% | 299 | 43.90% |
| Troponin* | ||||
| Normal | 2,135 | 61.00% | 266 | 63.60% |
| Abnormal | 1,367 | 39.00% | 152 | 36.40% |
| Lactate* | ||||
| Normal | 1,599 | 78.90% | 188 | 74.30% |
| Abnormal | 427 | 21.10% | 65 | 25.70% |
| Sodium* | ||||
| Normal | 3,347 | 60.40% | 384 | 56.40% |
| Abnormal | 2,194 | 39.60% | 297 | 43.60% |
| BNP | ||||
| Normal | 2,259 | 40.80% | 310 | 45.50% |
| Abnormal | 3,282 | 59.20% | 371 | 54.50% |
| Factor | Odds ratio | 95% CI | P 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. | |||
| LOS | 1.026 | 1.006, 1.047 | 0.013 |
| Age | 0.986 | 0.979, 0.993 | < 0.001 |
| Sex | 1.088 | 0.921, 1.285 | 0.32 |
| Race (other) | 0.875 | 0.599, 1.277 | 0.487 |
| Race (black) | 0.781 | 0.597, 1.021 | 0.07 |
| Diuretic time > 2 h | 1.29 | 1.018, 1.634 | 0.035 |
| Diuretic time, never | 1.555 | 1.237, 1.955 | < 0.001 |
| Elixhauser | 1.044 | 0.996, 1.093 | 0.072 |
| GDMT | 0.781 | 0.647, 0.944 | 0.011 |
| IV fluid | 0.921 | 0.704, 1.205 | 0.55 |
| Insured | 0.851 | 0.51, 1.419 | 0.536 |
| Diet | 1.155 | 0.952, 1.402 | 0.144 |
| Cardiac consult | 1.067 | 0.792, 1.437 | 0.67 |
| ICU flag | 1.665 | 1.274, 2.178 | < 0.001 |
| Vent | 1.267 | 0.816, 1.968 | 0.292 |
| X-ray ≤ 1 day | 0.881 | 0.646, 1.203 | 0.426 |
| Echo ≤ 1 day | 0.836 | 0.700, 0.998 | 0.047 |
| Max respiratory rate | 0.994 | 0.984, 1.004 | 0.258 |
| Min SpO2 | 1.011 | 0.995, 1.027 | 0.192 |
| Min pulse | 0.992 | 0.985, 0.9999 | 0.046 |
| Max systolic BP | 1.001 | 0.998, 1.0004 | 0.629 |
| Abnormal albumin | 1.119 | 0.924, 1.354 | 0.25 |
| Abnormal creatinine | 0.912 | 0.764, 1.090 | 0.313 |
| Abnormal sodium | 1.116 | 0.935, 1.331 | 0.224 |
| Abnormal BNP | 0.966 | 0.802, 1.164 | 0.717 |
| Factor | Odds ratio | 95% CI | P 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. | |||
| LOS | 0.917 | 0.892, 0.942 | < 0.001 |
| Age | 1.053 | 1.04, 1.065 | < 0.001 |
| Sex | 0.988 | 0.792, 1.233 | 0.915 |
| Race (other) | 0.502 | 0.271, 0.928 | 0.028 |
| Race (black) | 0.688 | 0.447, 1.058 | 0.089 |
| Diuretic > 2 h | 1.044 | 0.795, 1.372 | 0.755 |
| No diuretic | 0.68 | 0.504, 0.918 | 0.012 |
| Elixhauser | 1.267 | 1.196, 1.342 | < 0.001 |
| GDMT | 0.518 | 0.394, 0.682 | < 0.001 |
| IV fluid | 0.814 | 0.592, 1.118 | 0.204 |
| Insured | 0.498 | 0.123, 2.022 | 0.329 |
| Cardiac diet | 0.632 | 0.502, 0.797 | < 0.001 |
| Cardiac consult | 1.828 | 1.131, 2.953 | 0.014 |
| ICU flag | 2.127 | 1.583, 2.858 | < 0.001 |
| Vent | 4.89 | 3.314, 7.215 | < 0.001 |
| X-ray ≤ 1 day | 1.183 | 0.713, 1.962 | 0.515 |
| Echo ≤ 1 day | 0.606 | 0.483, 0.759 | < 0.001 |
| Max respiratory | 1.025 | 1.015, 1.035 | < 0.001 |
| Min SpO2 | 0.958 | 0.944, 0.972 | < 0.001 |
| Min pulse | 1.012 | 1.003, 1.022 | 0.01 |
| Max systolic | 0.996 | 0.991, 1 | 0.043 |
| Abnormal albumin | 1.651 | 1.276, 2.136 | < 0.001 |
| Abnormal creatinine | 1.688 | 1.330, 2.143 | < 0.001 |
| Abnormal sodium | 1.473 | 1.172, 1.852 | < 0.001 |
| Abnormal BNP | 2.268 | 1.687, 3.05 | < 0.001 |
| Variable | Odds ratio | 95% CI | P value |
|---|---|---|---|
| CI: confidence interval; ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation. | |||
| Readmit | 1.628 | 1.284, 2.065 | < 0.001 |
| Age | 0.988 | 0.981, 0.995 | < 0.001 |
| Sex | 1.179 | 0.997, 1.395 | 0.054 |
| Race (other) | 1.117 | 0.775, 1.608 | 0.554 |
| Race (black) | 0.561 | 0.416, 0.758 | < 0.001 |
| GDMT | 0.935 | 0.778, 1.122 | 0.47 |
| Diuretic > 2 h | 1.703 | 1.378, 2.103 | < 0.001 |
| Diuretic time, never | 1.259 | 0.997, 1.590 | 0.053 |
| Elixhauser | 1.089 | 1.042, 1.138 | < 0.001 |
| IV fluid | 2.306 | 1.860, 2.860 | < 0.001 |
| Cardiac consult | 1.702 | 1.152, 2.515 | 0.008 |
| Cardiac diet | 0.726 | 0.607, 0.869 | < 0.001 |
| X-ray ≤ 1 day | 1.217 | 0.840, 1.763 | 0.299 |
| Echo ≤ 1 day | 1.865 | 1.562, 2.227 | < 0.001 |
| Max respiratory | 1.055 | 1.047, 1.063 | < 0.001 |
| Min SpO2 | 0.991 | 0.979, 1.003 | 0.135 |
| Min pulse | 1.002 | 0.995, 1.009 | 0.557 |
| Max systolic | 1.004 | 1.000, 1.007 | 0.025 |
| Abnormal albumin | 2.964 | 2.448, 3.589 | < 0.001 |
| Abnormal creatinine | 1.14 | 0.956, 1.360 | 0.145 |
| Abnormal sodium | 1.577 | 1.331, 1.868 | < 0.001 |
| Abnormal BNP | 1.416 | 1.164, 1.723 | < 0.001 |
| Factor | Unstandardized coefficients | Standardized coefficient | 95% CI for B | P value | |
|---|---|---|---|---|---|
| B | Standard error | β | |||
| CI: confidence interval; ICU: intensive care unit; GDMT: guideline-directed medical therapy; IV: intravenous; BNP: brain natriuretic peptide; SpO2: oxygen saturation. | |||||
| (Constant) | 1.572 | 2.332 | -3.004, 6.149 | 0.5 | |
| Readmit | -0.145 | 0.366 | -0.012 | -0.864, 0.573 | 0.692 |
| Age | -0.007 | 0.011 | -0.019 | -0.029, 0.015 | 0.555 |
| Sex | 0.554 | 0.269 | 0.064 | 0.026, 1.081 | 0.04 |
| Race (other) | -0.108 | 0.579 | -0.006 | -1.245, 1.028 | 0.852 |
| Race (black) | -0.258 | 0.497 | -0.016 | -1.233, 0.718 | 0.604 |
| GDMT | 0.55 | 0.293 | 0.06 | -0.025, 1.126 | 0.061 |
| Diuretic > 2 h | 1.047 | 0.348 | 0.123 | 0.365, 1.729 | 0.003 |
| Diuretic time, never | -0.37 | 0.392 | -0.04 | -1.138, 0.399 | 0.346 |
| Elixhauser | 0.016 | 0.069 | 0.008 | -0.119, 0.151 | 0.813 |
| IV fluid | 1.717 | 0.312 | 0.177 | 1.104, 2.330 | < 0.001 |
| Cardiac consult | -0.699 | 0.657 | -0.033 | -1.988, 0.590 | 0.287 |
| Diet | -0.196 | 0.279 | -0.023 | -0.744, 0.352 | 0.483 |
| X-ray ≤ 1 day | -0.322 | 0.611 | -0.016 | -1.520, 0.877 | 0.599 |
| Echo ≤ 1 day | -0.083 | 0.276 | -0.009 | -0.625, 0.459 | 0.763 |
| Max respiratory | 0.051 | 0.011 | 0.155 | 0.029, 0.072 | < 0.001 |
| Min SpO2 | -0.017 | 0.017 | -0.035 | -0.049, 0.016 | 0.312 |
| Min pulse | -0.016 | 0.011 | -0.049 | -0.037, 0.005 | 0.129 |
| Max systolic | 0.005 | 0.005 | 0.035 | -0.004, 0.015 | 0.293 |
| Abnormal albumin | 1.121 | 0.333 | 0.112 | 0.467, 1.774 | < 0.001 |
| Abnormal creatinine | 0.646 | 0.287 | 0.074 | 0.084, 1.209 | 0.024 |
| Abnormal sodium | 1.098 | 0.281 | 0.125 | 0.546, 1.650 | < 0.001 |
| Abnormal BNP | 0.44 | 0.317 | 0.045 | -0.182, 1.061 | 0.166 |