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Observational Study
. 2015 Oct;17(10):1032-41.
doi: 10.1002/ejhf.290. Epub 2015 May 27.

The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry

Giuseppe Di Tano  1 , Renata De Maria  2 , Lucio Gonzini  3 , Nadia Aspromonte  4 , Andrea Di Lenarda  5 , Mauro Feola  6 , Marco Marini  7 , Massimo Milli  8 , Gianfranco Misuraca  9 , Andrea Mortara  10 , Fabrizio Oliva  11 , Giovanni Pulignano  12 , Giulia Russo  5 , Michele Senni  13 , Luigi Tavazzi  14 ; IN-HF Outcome Investigators
Collaborators, Affiliations
Free article
Observational Study

The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry

Giuseppe Di Tano et al. Eur J Heart Fail. 2015 Oct.
Free article

Abstract

Aims: Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial.

Methods and results: Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age.

Conclusion: A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.

Keywords: 30-Day readmission; Acute heart failure; Days-alive-out-of-hospital; mortality.

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