Trends in 30-day readmissions following hospitalisation for heart failure by sex, socioeconomic status and ethnicity

C Lawson; H Crothers; S Remsing; I Squire; F Zaccardi; M Davies; L Bernhardt; K Reeves; R Lilford; K Khunti

doi:10.1016/j.eclinm.2021.101008

Trends in 30-day readmissions following hospitalisation for heart failure by sex, socioeconomic status and ethnicity

EClinicalMedicine. 2021 Jul 14:38:101008. doi: 10.1016/j.eclinm.2021.101008. eCollection 2021 Aug.

Authors

C Lawson^{1

2}, H Crothers³, S Remsing³, I Squire¹, F Zaccardi^{2

4}, M Davies⁴, L Bernhardt¹, K Reeves³, R Lilford³, K Khunti^{2

4}

Affiliations

¹ Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
² Real World Evidence Unit, University of Leicester, UK.
³ University of Birmingham, UK.
⁴ Diabetes Centre, University of Leicester, UK.

Abstract

Background: Reducing the high patient and economic burden of early readmissions after hospitalisation for heart failure (HF) has become a health policy priority of recent years.

Methods: An observational study linking Hospital Episode Statistics to socioeconomic and death data in England (2002-2018). All first hospitalisations with a primary discharge code for HF were identified. Quasi-poisson models were used to investigate trends in 30-day readmissions by age, sex, socioeconomic status and ethnicity.

Findings: There were 698,983 HF admissions, median age 81 years [IQR 14].In-hospital deaths reduced by 0.7% per annum (pa), whilst additional deaths at 30-days remained stable at 5%. Age adjusted 30-day readmissions (21% overall), increased by 1.4% pa (95% CI 1.3-1.5). Readmissions for HF (6%) and 'other cardiovascular disease (CVD)' (3%) remained stable, but readmissions for non-CVD causes (12%) increased at a rate of 2.6% (2.4-2.7) pa. Proportions were similar by sex but trends diverged by ethnicity. Black groups experienced an increase in readmissions for HF (1.8% pa, interaction-p 0.03) and South Asian groups had more rapidly increasing readmission rates for non-CVD causes (interaction-p 0.04). Non-CVD readmissions were also more prominent in the least (15%; 15-15) compared to the most affluent group (12%; 12-12). Strongest predictors for HF readmission were Black ethnicity and chronic kidney disease, whilst cardiac procedures were protective. For non-CVD readmissions, strongest predictors were non-CVD comorbidities, whilst cardiologist care was protective.

Interpretation: In HF, despite readmission reduction policies, 30-day readmissions have increased, impacting the least affluent and ethnic minority groups the most.

Funding: NIHR.

Keywords: AF, Atrial fibrillation; CI, Confidence Interval; COPD, Chronic obstructive pulmonary disease; CRT, Cardiac resynchronisation therapy; CVA, Cerebrovascular accident; CVD, Cardiovascular disease; HES, Hospital Episode Statistics; HF, Heart failure; Heart failure; ICD, Implantable cardioverter defibrillator; IHD, Ischaemic heart disease; IMD, Index of Multiple Deprivation; MI, Myocardial infarction; ONS, Office of National Statistics; PCI, Percutaneous coronary intervention; Readmission; hospitalisation.