Background Patients with chronic congestive heart failure (CHF) require frequent rehospitalization because of the exacerbation of CHF. It is of clinical importance to determine predicting factors for readmission to reduce this likelihood. Previous studies have focused primarily on the demographic and medical characteristics in selected subsets of patients. Therefore, within a broad cohort of consecutively hospitalized patients, we sought to identify not only demographic and medical predictors but also socioenvironmental factors associated with readmission. Methods We assessed demographic (age, sex), medical (etiology of CHF, New York Heart Association functional class, left ventricular ejection fraction, previous admission for CHF, length of hospital stay, comorbidity, and medications), and socioenvironmental variables (occupation, financial resources, living alone, and follow-up visits) in 230 patients discharged with a diagnosis of CHF and recorded hospital readmission. Results Within 1 year after discharge, 81 patients (35%) were readmitted. Five variables, including poor follow-up visits (odds ratio [OR] 4.9, 95% CI 2.0-11.8), previous admission for CHF (OR 3.3, 95% CI 1.8-6.1), no occupation (OR 2.6, 95% CI 1.2-5.5), longer hospital stay (OR 3.2, 95% CI 1.2-8.5), and hypertension (OR 2.0, 95% CI 1.1-3.7), were identified as significant independent predictors for readmission by multivariate logistic regression analysis. Conclusions Our independent predictors of readmission support the importance of medical and socioenvironmental factors in the deterioration of CHF. Therefore interventions to decrease readmission should also target social management in all hospitalized patients. (Am Heart J 2001;142:e7.)
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Study patients
The study institutions included 5 cardiology units (1 university hospital and 4 nearby hospitals) serving as primary, secondary, and tertiary referral medical centers for cardiovascular patients in Fukuoka, Japan, which has 1.3 million residents. There are several other hospitals with cardiology wards that care for CHF patients, and thus 5 hospitals enrolled in this study did not capture all CHF patients in the study area. The institution medical records identified all patients discharged with
Patient characteristics
Among 3654 patients admitted to 5 participating hospitals during the study period, 263 patients were discharged with a principal diagnosis of CHF. Twenty-six patients (10%) had medical records that did not meet Framingham criteria. Seven patients (2.7%) refused to participate in the study. Thus the remaining 230 patients were included in the current study.
The demographic and clinical characteristics are summarized in Tables II and III, part of which has been reported in our recent study.8Many
Discussion
The major findings of the current study are (1) the readmission rate of patients with CHF is high (35% within 1 year after discharge), (2) patients with a prior history of hospitalization with CHF, hypertension, and longer hospital stay at index admission are at increased risk for readmission, and (3) socioenvironmental factors including poor follow-up and no occupation were also independent predictors associated with CHF readmission. Of the 40 potential predictors, only 5 were found to be
Acknowledgements
Participating investigators constituting the study hospitals are as follows; Samon Koyanagi, MD (National Kyushu Medical Center Hospital); Tetsuji Inou, MD, and Masami Matsuyama, RN (Fukuoka Red Cross Hospital); Yuji Maruoka, MD (Hamanomachi Hospital); Yusuke Yamanoto, MD, and Koji Todaka, MD (Saiseikai Fukuoka General Hospital). This study could not have been carried out without the help, cooperation, and support of the cardiologists in the study hospitals. We also thank the administrators for
