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European J of Heart Fail - 2021 - - Supplement Article.pdf (805.23 kB)

16-year trends in 30-day cause specific readmissions following hospitalisation for heart failure in england by sex, socioeconomic status and ethnicity.

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posted on 2024-01-25, 14:20 authored by C Lawson, H Crother, S Remsing, I Squire, F Zaccardi, M Davies, L Bernhardt, K Reeves, R Lilford, K Khunti

Background: Reducing the high cost and burden of early readmissions after hospitalisation for HF has become a health policy priority of recent years, yet prior trend data are conflicting and UK data are scarce. This study investigates 16-year trends in 30-day cause-specific readmissions after hospitalisation for heart failure (HF), by gender, socioeconomic status and ethnicity.


Methods: Using Hospital Episodes Statistics linked to socioeconomic and death data, we identified index admissions for HF in England (2002-2018). Trends in 30-day cause-specific readmissions by gender, socioeconomic status and ethnicity were estimated and patient characteristics of readmission were identified.


Results: There were 698.983 index admissions for HF, median age 81 years [IQR 14], 50% male, 82% White, 3.1% South Asian, 1.7% Black, 16% most and 22% least affluent. In hospital deaths occurred in 108.798 patients (16%), but reduced from 20% to 12% over time (Figure 1a). A further 31.178 deaths (5%) occurred by 30 days. Between 2002-2006 and 2014-2018, age adjusted 30-day readmissions for any cause increased from 19% to 22%, an average increase of 1.4% (95% CI 1.3, 1.5) per annum. Readmissions for HF (6%) and ‘other CVD’ (3%) remained stable but readmissions for non-CVD causes increased from 10% to 13% at a rate of 2.6% (2.4, 2.7) per annum (Figure 1). Rates were similar by gender but there were diverging trends by ethnicity. Black groups experienced a 50% increase in readmissions for HF (6% to 9%, interaction-p 0.03) and South Asian groups had more rapidly increasing rates of readmissions for non-CVD causes (interaction-p 0.04). Non-CVD readmissions (12%) were also more prominent in the least (15%; 15, 15) compared to the most affluent group (12%; 12, 12) (see Table). Strongest predictors for HF readmission were Black ethnicity and CKD, whilst cardiac procedures and cardiologist care during the index admission were protective. For non-CVD readmissions, strongest predictors were non-CVD comorbidities (Cancer, COPD, CVA and depression), whilst cardiologist care was protective.


Conclusions: In HF, despite readmission reduction policies, 30-day readmissions have been increasing. This change is driven by non-cardiovascular causes and impacts the least affluent and ethnic minority groups the most. Readmission reduction programmes require close consideration of patient factors and a multidisciplinary approach to specialist non-cardiovascular care.



Funding

National Institute for Health Research (NIHR) Advanced fellowship

History

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Source

Abstracts of the Heart Failure 2021 and the World Congress on Acute Heart Failure, 29 June - 1 July 2021, Online Congress

Version

  • VoR (Version of Record)

Published in

EUROPEAN JOURNAL OF HEART FAILURE

Volume

23

Issue

S2:Supplement: Abstracts of the Heart Failure 2021 and the World Congress on Acute Heart Failure, 29 June ‐ 1 July 2021, Online Congress

Pagination

83 - 84

Publisher

WILEY

issn

1388-9842

eissn

1879-0844

Copyright date

2021

Available date

2024-01-25

Language

en

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