Predicting Factors to 30-Day Hospital Readmission in Patients with Acute Heart Failure

Abstract

This prospective cohort study aimed to investigate the readmission rate of 30-day readmission with acute heart failure (AHF) and the predicting factors including comorbidity severity, malnutrition, family support, self-care, and post-discharge follow-up methods. Andersen’s behavioral model of health service was employed as a framework guiding this study. The sample comprised 163 hospitalized patients with heart failure, both male and female, aged 18 years and older, who had discharge plans from two super tertiary hospitals in Bangkok. Data were collected between February and September 2022 using a general profile questionnaire, the Charlson Comorbidity Index (CCI), Controlling Nutritional Status (CONUT), the Family Adaptation,  Partnership, Growth,  Affection,  and Resolution Questionnaire (APGAR), the Self-Care of Heart Failure Index (SCHFI), and a post-discharge questionnaire.  The instruments were validated, and the reliability testing results ranged from 0.86 to 1.0. The data were analyzed using descriptive statistics, Chi-square test, and Point-biserial correlation. Logistic regression analysis was employed to examine the predictive power of 30-day readmission risk, with the statistical significance level set at .05.

The study’s results revealed that the average age of participants was 66.23 years old (SD = 15.53). Among the participants, 53.4% were female, had a moderate level of comorbidity severity (Mean = 4.60, SD = 2.32), 50.3% had mild malnutrition, and had a high level of family support (Mean = 17.55, SD = 3.98). The level of self-care was found inadequate in all three aspects of self-care maintenance (Mean = 65.33, SD = 15.43), symptom perception (Mean = 61.13, SD = 17.83), and self-care management (Mean = 55.18, SD = 17.45). The follow-up methods were mainly hospital visit with a cardiologist (83.4%). The readmission rate was found to be 11.0% of the total sample. The comorbidity severity and malnutrition variables were significantly correlated with 30-day readmission with AHF (r_pb = .240, and
r_pb = .204, respectively). The predictive factors of 30-day readmission with AHF included inadequate self-care maintenance (OR = 4.522, 95% CI = 1.083–18.885, p = 0.039), comorbid severity (OR = 1.331, 95% CI = 1.070–1.657, p = 0.010), and malnutrition (OR = 1.325, 95% CI = 1.033–1.700, p = 0.026).

Recommendations to effectively reduce the risks of 30-day readmission associated with AHF, nurses should develop a comprehensive discharge planning program by concerning the severity of comorbidities, assess and coordinate for patients to receive an appropriate diagnosis and management of malnutrition, and patient education specific to self-care for HF.