Readmissions up mortality risk in heart failure patients

In heart failure (HF) patients, readmissions due to worsening condition is common and may be an indicator of worse clinical outcomes and mortality risk, a recent Japan study has found.

From the Japanese Diagnosis Procedure Combination Database, the researchers identified 331,259 HF patients (median age, 81 years; 52.9 percent male) who had been first hospitalized for HF between January 2010 and March 2018. Participants were then grouped according to the number of times they were admitted: once, twice, thrice, four times, and five or more times.

Respiratory support and the use of inotropics were more commonly recorded in patients who had been readmitted, and the need for either grew with increasing admissions. In-hospital deaths showed a similar pattern of interaction with hospital admissions, while discharge to home showed the opposite trend.

Multivariable logistic regression analysis confirmed these findings. Being hospitalized just twice significantly increased the likelihood of in-hospital mortality by more than 50 percent (odds ratio [OR], 1.57, 95 percent confidence interval [CI], 1.50–1.64; p<0.001).

This risk of death further increased with more hospitalizations. Those who had been admitted thrice were twice as likely to die (OR, 2.01, 95 percent CI, 1.89–2.14; p<0.001), while those who were hospitalized at least five times saw an almost threefold increase in in-hospital mortality risk (OR, 2.83, 95 percent CI, 2.59–3.08; p<0.001).

“To date, it has not been concluded whether each hospital admission due to HF could deteriorate clinical outcomes. Our comprehensive analysis of a large-scale nationwide database clearly demonstrated that the risk of in-hospital death increased in association with an increasing number of hospital admissions,” the researchers said.