Hospital Readmissions for Heart Failure Linked to Higher Rates of 3-Year Mortality

Within 1 year of follow-up post hospital discharge, 61.3% of patients with hypertension and a first diagnosis of heart failure required readmittance and 21.4% died, according to a recent study in Journal of Clinical Hypertension.

For this population-based cohort study, the Myocardial Infarction Data Acquisition System, which tracks hospitalizations for cardiovascular (CV) disease in New Jersey, provided data on 51,141 patients with hypertension and a first diagnosis of heart failure who were discharged from a hospital between January 1, 2000, and December 31, 2014. Their mean (SD) age at first heart failure admission was 74.9 (1.1) years.

The primary outcome was change in 3-year mortality, and multivariable logistic regression was used to measure temporal trends in the following for up to 1 year following discharge:

• Mortality
• Heart failure–specific readmission
• All-cause readmissions

Logistic regression linked being male (odds ratio [OR], 1.18; 95% CI, 1.12-1.23) and Black (OR, 1.25; 95% CI, 1.17-1.33) with a higher likelihood of all-cause mortality and hospital readmission for heart failure within 1 year (P < .001), while 3-year mortality significantly increased if a patient had to be readmitted with 1 year (P < .001) and readmission for any cause was linked with higher 3-year mortality compared with those not requiring readmission (P < .001).

In addition, all-cause readmissions increased during the study (P < .001), from 30 days (20.7%) to 1 year (61.29%) post initial hospitalization discharge, but heart failure readmissions and mortality did not. Also, other predictors of all-cause readmission included atrial fibrillation (OR, 1.08; 95% CI, 1.04-1.13), diabetes (OR, 1.23; 95% CI, 1.18-1.28), and hyperlipidemia (OR, 1.14; 95% CI, 1.10-1.19).

The authors were seeking a more complete comparison of secular changes and long-term mortality between patients with heart failure and hypertension requiring hospital readmittance compared with those who did not have to be readmitted. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify diagnoses of hypertension, heart failure, and comorbidities.

Overall, although all-cause readmissions rose at 1 year—the most common reasons being heart failure, respiratory and other heart-related conditions, and chronic kidney disease—patients with heart failure and a history of hypertension did not experience a significant uptick in CV mortality over the study period, which the authors “attributed to a decreased case fatality of [acute myocardial infarction].”

“The take home message of this study is that attention to modifiable risk factors such as diabetes and hypercholesterolemia and discharge management to prevent a clinical deterioration after hospitalization would result in improved outcomes,” the authors concluded. “Therefore, physicians treating [heart failure] patients with history of hypertension in addition to adhering to current guidelines should safeguard the management of comorbidities and the appropriate discharge planning.”

Reference

Giakoumis M, Sargsyan D, Kostis JB, et al. Readmission and mortality among heart failure patients with history of hypertension in a statewide database. J Clin Hypertens. 2020;22:1263-1274. doi:10.1111/jch.13918