Predictors of readmission among elderly survivors of admission with heart failure

Background Readmission rates for patients discharged with heart failure app roach 50% within 6 months. Identifying factors to predict risk of readmissi on in these patients could help clinicians focus resource-intensive disease management efforts on the high-risk patients. Methods The study sample included patients 65 years of age or older with a principal discharge diagnosis of heart Failure who were admitted to 18 Conn ecticut hospitals in 1994 and 1995. We obtained patient and clinical data f rom medical record review. We determined outcomes within 6 months after dis charge, including all-cause readmission, heart failure-related readmission, and death, from the Medicare administrative database. We evaluated 2176 pa tients, including 1129 in the derivation cohort and 1047 in the validation cohort. Results of 32 patient and clinical factors examined, 4 were found to be sig nificantly associated with readmission in a multivariate model. They were p rior admission within 1 year, prior heart failure, diabetes, and creatinine level >2.5 mg/dL at discharge. The event rates according to number of risk predictors were similar in the derivation and the validation sets for all outcomes. in the validation cohort, rates for all-cause readmission and com bined readmission or death were 26% and 31% in patients with no risk predic tors, 48% and 54% in patients with 1 or 2 risk predictors, and 59% and 65% in patients with 3 or all risk predictors. Conclusions Few patient and clinical factors predict readmission within 6 m onths after discharge in elderly patients with heart failure. Although we w ere unable to identify a group of patients at very low risk, a group of hig h risk patients were identified for whom resource-intensive interventions d esigned to improve outcomes may be justified.