Assessment of Discharge Readiness and Readmission Risk in Patients With Acute Decompensated Heart Failure

Area of Science:

• Cardiology
• Health Services Research

Background:

• Acute heart failure (HF) readmissions pose a significant clinical challenge.
• Failure to achieve euvolemia (normal fluid balance) at discharge is a known risk factor for HF readmission.

Purpose of the Study:

• To investigate the association between discharge documentation practices and readmission risk in acute decompensated heart failure patients.
• To determine if specific documentation of volume status influences 30-day and 6-month readmission rates.

Main Methods:

• Retrospective cohort study of 100 adult patients admitted for acute HF syndrome.
• Analysis of discharge summaries (DS) for documentation of physical exam findings and volume status.
• Coprimary outcomes included 30-day and 6-month all-cause readmissions or emergency department visits.

Main Results:

• 18% of patients experienced 30-day all-cause readmission; 12% had HF-related readmission.
• Documentation of a normal jugular venous pulse was more frequent in patients not readmitted (53.2% vs 12.5%, p=0.03).
• Discussion of jugular venous pulse improvement also occurred more in non-readmitted patients (8.5% vs 0%, p=0.03).

Conclusions:

• Documenting markers of euvolemia in discharge summaries was associated with reduced 30-day readmission rates.
• Improved documentation of volume status assessment in DS may help mitigate HF readmission risk.