CORRELATES OF EARLY HOSPITAL READMISSION OR DEATH IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

Among patients with heart failure who survive an admission to the hosp ital, those who are readmitted or die soon after discharge may warrant special attention. Therefore, we prospectively followed 257 patients admitted nonelectively to an urban university hospital, with a complai nt of shortness of breath or fatigue and evidence of congestive heart failure on admission chest radiograph, who were discharged alive, Thro ugh survey of patients and families, review of the hospital computer s ystem, and a search of the National Death Index, we recorded death and hospital readmission. Within 60 days of discharge, 13 patients (5%) d ied and 82 (32%) died or were readmitted to the hospital. Using Cox pr oportional-hazards modeling, the multivariable correlates of readmissi on or death were single marital status (adjusted hazard ratio [HR] 2.1 ,95% confidence interval [CI] 1,3 to 3.3), Charlson Comorbidity Index score (HR 1.3 per point to maximum 4 points, 95% CI 1.1 to 1.6), admis sion systolic blood pressure of less than or equal to 100 mm Hg (HR 2. 8, 95% CI 1,6 to 5.0), and absence of new ST-T-wave changes on the ini tial electrocardiogram (HR 1,9, 95% CI 1.1 to 3.3), Self-reported pati ent compliance and clinical instability at discharge were not correlat es, Almost all patients stratified by these factors had at least a 25% risk of readmission or death, Our independent correlates of readmissi on or death support the importance of both medical and social factors in the pathway to clinical decline, However, we could not reliably ide ntify a truly low-risk group, Interventions to decrease early readmiss ion or death among patients with heart failure should target both medi cal management and the adequacy of social support, and probably need t o be applied to all admitted patients. (C) 1997 by Excerpta Medica, In c.