Identification of high risk patients who are prone to early hospital readmissions for congestive heart failure

Multiple hospital admissions (MA) in patients with congestive heart failure (CHF) are a major social and economic concern, but factors predictive of MA have not been clarified. Therefore, we evaluated 249 patients with 545 MA for CHF (22 admissions in 3.5 yr, range 1-10 admissions). The study group comprised 133 men (63 yr, range 21-93) and 116 women (69 yr, range 33-100). More than half of the patients (55%, n=136) had a history of early readmission (ERA) for CHF (≤90 days following the initial CHF discharge) (group I). These patients averaged 2.9 admissions (range 1-10) for CHF during the study period. By contrast, patients without a history of ERA (group II) (45%, n=113) averaged only 1.2 admissions (range 1-4, p<.001) during the study interval. There were no significant differences between groups I and II with respect to: age (66 yr vs 66 yr), sex (59% male vs 47% male), duration of presenting symptoms (6.7 days vs 6.9 days), atrial fibrillation (22% vs 16%), left ventricular shortening fraction (22% vs 25%), echocardiographic evidence of mitral regurgitation (32% vs 29%), coronary artery disease (60% vs 52%), hypertension (67% vs 70%), diabetes (32% vs 48%), serum creatinine (2.2 vs 2.1 mg/dL), serum sodium (138 vs 138 meq/L), serum potassium (4.3 vs 4.3 meq/L), angiotensin converting enzyme inhibitors (53% vs 50%), digoxin (56%, vs 46%), diuretics (84% vs 76%), admission systolic blood pressure (132 vs 136 mm Hg), and heart rate (91 vs 92 bpm). Thus, MA were not related to traditional predictors of CHF etiology, clinical course or management but were associated with ERA. In fact, MA patients with a history of a single ERA for CHF went on to readmit almost 2.5 times more than patients without an ERA history, and therefore constitute a high risk group which require increased surveillance.