IJCS | Volume 33, Nº2, March / April 2020

DOI: https://doi.org/10.36660/ijcs.20180088 175 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2020; 33(2):175-184 Mailing Address: Camila Sarteschi REALCOR - Núcleo de Cardiologia do Real Hospital Português - Av. Agamenon Magalhães, 4760. Postal Code: 52010-900, Derby, Recife, PE - Brazil. E-mail: csarteschi@hotmail.com Predictors of Post-Discharge 30-Day Hospital Readmission in Decompensated Heart Failure Patients Camila Sarteschi, 1 W ayner Viera de Souza, 2 C arolina Medeiros, 1 P aulo Sergio Rodrigues Oliveira, 1 S ilvia Marinho Martins, 3 E duarda Ângela Pessoa Cesse 2 Real Hospital Português de Beneficência em Pernambuco – REALCOR, 1 Recife, PE - Brazil Centro de Pesquisas Aggeu Magalhães – FIOCRUZ, 2 Recife, PE - Brazil Pronto Socorro Cardiológico de Pernambuco Professor Luiz Tavares – PROCAPE, 3 Recife, PE - Brazil Manuscript received on December 13, 2018, revised manuscript on January 16, 2019, accepted on February 27, 2019. Abstract Background: Heart failure (HF) is worldwide known as a public health issue with high morbimortality. One of the issues related to the evolution of HF is the high rate of hospital readmission caused by decompensation of the clinical condition, with high costs and worsening of ventricular function. Objective: To quantify the readmission rate and identify the predictors of rehospitalization in patients with acute decompensated heart failure. Methods: Hospital-based historic cohort of patients admitted with acute decompensated HF in a private hospital from Recife/PE, from January 2008 to February 2016, followed-up for at least 30 days after discharge. Demographic and clinical data of admission, hospitalization, and clinical and late outcomes were analyzed. Logistic regression was used as a strategy to identify the predictors of independent risks. Results: 312 followed-up patients, average age 73 (± 14), 61% males, 51% NYHA Class III, and 58% ischemic etiology. Thirty-day readmission rate was 23%. Multivariate analysis identified the independent predictors ejection fraction < 40% (OR = 2.1; p = 0.009), hyponatremia (OR = 2.9; p = 0.022) and acute coronary syndrome (ACS) as the cause of decompensation (OR = 1.1; p = 0,026). The final model using those three variables presented reasonable discriminatory power (C-Statistics = 0.655 – HF 95%: 0.582 – 0.728) and good calibration (Hosmer-Lemeshow p = 0.925). Conclusions: Among hospitalized patients with acute decompensated heart failure, the rate of readmission was high. Hyponatremia, reduced ejection fraction and ACS as causes of decompensation were robust markers for the prediction of hospital readmission within 30 days of discharge. (Int J Cardiovasc Sci. 2020; 33(2):175-184) Keywords: Heart Failure; Hospitalization; Patient Readmission; Patient Discharge/trends. Introduction Heart failure (HF) is a chronic disease associated with high morbidity and mortality and is known worldwide as a public health issue due to its significantly increased incidence, especially amongst the elderly population. It is estimated that the prevalence of HF varies from 1% of people under 50 to 10% of people over 80 years of age. 1 According to North American data, HF affects around 5.5 million patients. Annually, it presents an incidence of 660,000 new cases, with 800,000 to 3.6million hospitalizations, 300,000 deaths per year and related costs of around 35 billion dollars, being the fifth most frequent cause of hospitalization and the most common amongst the elderly. 2 In Brazil, according to data from the National Health System – DATASUS (2017), in 2016, there were around 214,000 hospitalizations due to HF, which is 19% of the hospitalizations for cardiovascular diseases, with in-hospital mortality of 11% and costs related to