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Risk Factors Associated With 7- Versus 30-Day Readmission Among Patients With Heart Failure Using the Nationwide Readmission Database

Pham, Phuong N., MS; Xiao, Hong, PhD; Sarayani, Amir, PharmD, MPH; Chen, Ming, MS; Brown, Joshua D., PharmD, PhD

doi: 10.1097/MLR.0000000000001006
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Background: The 30-day all-cause readmission for heart failure (HF) is a standard measure to evaluate hospital performance. A recent study found that a shorter period after discharge may be more indicative of hospital quality.

Objective: To compare risk factors for 7- versus 30-day readmission in patients with HF.

Design: This is a retrospective cohort using the 2014 Nationwide Readmissions Database.

Subjects: Patients 65 years and older with Medicare coverage discharged after HF admission.

Measures: The 7- or 30-day all-cause readmissions were the outcomes of interest. HF-related readmissions were secondary outcomes. Covariates included patient characteristics, hospital characteristics, and admission-related information. Hierarchical logistic regression evaluated the association between covariates and readmissions.

Results: There were N=15,039 all-cause readmissions within 7 days after discharge and N=47,896 within 30 days. Surgical service was a risk factor for 30-day but not 7-day all-cause readmission (odds ratio=1.10, 95% confidence interval=1.05–1.16). Depression, rheumatoid arthritis, liver disease, drug abuse, lymphoma, and psychosis were associated with an increased risk of 30-day all-cause readmission but not 7-day. Longer lengths of stay also had a higher likelihood of all-cause readmission within 30 days compared with 7 days. In contrast, smaller hospital bed size was associated with an increased risk of 7-day all-cause readmission (odds ratio=1.06, confidence interval=1.01–1.12) but not 30-day. Sensitivity analysis with using a 3-day readmission interval showed similar results.

Conclusions: Risk factors for hospital readmission are slightly different dependent on the measurement interval. In general, hospital-related factors were associated with shorter readmissions intervals while patient factors were more associated with longer intervals.

Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL

The authors declare no conflict of interest.

Reprints: Joshua D. Brown, PharmD, PhD, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, HPNP #3320, Gainesville, FL 32611. E-mail: joshua.brown@ufl.edu.

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