Predictors of 90-day Readmission After Hospitalization in Heart Failure with Reduced Ejection Fraction Patients: A Single-Centre Analytical Cohort Retrospective Study
DOI:
https://doi.org/10.30701/ijc.2072Keywords:
Predictors, Readmission, Acute Decompensated Heart Failure, HFrEF, SGLT2 InhibitorsAbstract
Background: Heart failure with Reduced Ejection Fraction (HFrEF) is a chronic condition frequently associated with recurrent hospitalizations. These readmissions compromise patient outcomes and impose significant burdens on healthcare systems. Identifying high-risk HFrEF patients enables treatment optimization. This single-center analytical study investigates predictors of 90-day readmission after hospitalization in HFrEF patients.
Methods: This retrospective cohort study enrolled patients with Left Ventricular Ejection Fraction (LVEF) ?40% who were admitted to the Cardiology Department Emergency Room at Adam Malik General Hospital for Acute Decompensated Heart Failure (ADHF) from January 2023 to January 2025 using consecutive sampling, followed for 90 days post-discharge. Statistical analyses included Mann-Whitney U, independent t-tests, chi-square, and backward stepwise multivariate logistic regression.
Results: Of 180 patients (71 rehospitalized, 109 non-rehospitalized), multivariate analysis identified five independent predictors of 90-day readmission: Length of Stay (LOS) >7 days (p<0.001, OR 7.854, 95% CI 3.216-19.179), prior Chronic Kidney Disease (CKD) (p=0.008, OR 3.989, 95% CI 1.430-11.131), lower LVEF (p<0.001, OR 0.844, 95% CI 0.777-0.916), Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitor non-use (p=0.006, OR 0.116, 95% CI 0.025-0.544), and lower admission Hemoglobin (Hb) (p=0.028, OR 0.803, 95% CI 0.661-0.976). Kaplan-Meier analysis revealed significant differences in 90-day rehospitalization-free survival across clinical subgroups. Rehospitalized patients had a median survival of 42 days versus 72 days for non-rehospitalized patients (log-rank p<0.001). SGLT2 inhibitor users during index hospitalization showed the strongest curve separation despite a small sample (n=4 vs n=15; log-rank p=0.002), while prolonged LOS >7 days, CKD, and anemia independently predicted worse outcomes (all log-rank p<0.001).
Conclusions: In HFrEF patients, longer LOS >7 days, prior CKD, lower LVEF, lower admission Hb, and lack of inpatient SGLT2 inhibitor use independently predicted 90-day readmission.
Downloads
References
1. McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–726.
2. Yan T, Zhu S, Yin X, Xie C, Xue J, Zhu M, et al. Burden, Trends, and Inequalities of Heart Failure Globally, 1990 to 2019: A Secondary Analysis Based on the Global Burden of Disease 2019 Study. J Am Heart Assoc [Internet]. 2023;12(6):1–13. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.122.027852
3. Feng J, Zhang Y, Zhang J. Epidemiology and Burden of Heart Failure in Asia [Internet]. JACC: Asia. Elsevier; 2024. p. 249–64. Available from: https://www.jacc.org/doi/10.1016/j.jacasi.2024.01.013
4. Wang Y, Wang Y, Zhang W. The utility of the adjusted-optimize-hf risk model for predicting in-hospital length of stay in the Chinese population. Ann Palliat Med. 2021;10(2):1445–55.
5. Reyes, E.B., Ha, J., Firdaus, I., Siu, C.W., Yin, W et al. Heart failure across Asia: Same healthcare burden but differences in organization of care. Int J Cardiol. 2016;223:163–7.
6. Jackson JDS, Cotton SE, Wirta SB, Proenca CC, Zhang M, Lahoz R, et al. Burden of heart failure on caregivers in China: results from a cross-sectional survey. Drug Des Devel Ther. 2018;12:78–1669.
7. McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation. 2015;131(20):1796–803.
8. Fudim M, O’Connor CM, Dunning A, Ambrosy AP, Armstrong PW, Coles A, et al. Aetiology, timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND-HF. Eur J Heart Fail. 2018;20(2):304–14.
9. Desai AS, Stevenson LW. Rehospitalization for Heart Failure. Circulation. 2012;126(4):501–6.
10. Khan MS, Sreenivasan J, Lateef N, Abougergi MS, Greene SJ, Ahmad T, et al. Trends in 30- and 90-Day Readmission Rates for Heart Failure. Circ Hear Fail. 2021;14(4):e:008335.
11. Caughey MC, Sueta CA, Stearns SC, Shah AM, Rosamond WD, Chang PP. Recurrent Acute Decompensated Heart Failure Admissions for Patients With Reduced Versus Preserved Ejection Fraction (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2018;122(I):108–14.
12. Park J, Zhong X, Babaie Sarijaloo F, Wokhlu A. Tailored risk assessment of 90-day acute heart failure readmission or all-cause death to heart failure with preserved versus reduced ejection fraction. Clin Cardiol. 2022;45(4):370–8.
13. Tripoliti EE, Papadopoulos TG, Karanasiou GS, Naka KK, Fotiadis DI. Heart Failure: Diagnosis, Severity Estimation and Prediction of Adverse Events Through Machine Learning Techniques. Comput Struct Biotechnol J. 2016;15:26–47.
14. Samsky MD, Ambrosy AP, Youngson E, Liang L, Kaul P, Hernandez AF, et al. Trends in Readmissions and Length of Stay for Patients Hospitalized with Heart Failure in Canada and the United States. JAMA Cardiol. 2019;4(5):444–53.
15. Sud M, Yu B, Wijeysundera HC, Austin PC, Ko DT, Braga J, et al. Associations Between Short or Long Length of Stay and 30-Day Readmission and Mortality in Hospitalized Patients With Heart Failure. JACC Hear Fail. 2017;5(8):578–88.
16. Omar HR, Guglin M. Longer-than-average length of stay in acute heart failure: Determinants and outcomes. Herz. 2018;43(2):131–9.
17. Lawson CA, Tay WT, Bernhardt L, Richards AM, Zaccardi F, Tromp J, et al. Association Between Diabetes, Chronic Kidney Disease, and Outcomes in People With Heart Failure From Asia. JACC Asia. 2023;3(4):611–21.
18. Swindle JP, Chan WW, Waltman Johnson K, Becker L, Blauer-Peterson C, Altan A. Evaluation of mortality and readmissions following hospitalization with heart failure. Curr Med Res Opin. 2016;32(10):1745–55.
19. Saito M, Negishi K, Marwick TH. Meta-Analysis of Risks for Short-Term Readmission in Patients with Heart Failure. Am J Cardiol. 2016;117(4):626–32.
20. Ye S dong, Wang SJ, Wang GG, Li L, Huang Z wei, Qin J, et al. Association between anemia and outcome in patients hospitalized for acute heart failure syndromes: findings from Beijing Acute Heart Failure Registry (Beijing AHF Registry). Intern Emerg Med. 2021;16(1):183–92.
21. Kajimoto K, Minami Y, Otsubo S, Sato N. Association of admission and discharge anemia status with outcomes in patients hospitalized for acute decompensated heart failure: Differences between patients with preserved and reduced ejection fraction. Eur Hear J Acute Cardiovasc Care. 2019;8(7):606–14.
22. Al-Tamimi MAA, Gillani SW, Abd Alhakam ME, Sam KG. Factors Associated With Hospital Readmission of Heart Failure Patients. Front Pharmacol. 2021;12.
23. Schjødt I, Liljeroos M, Larsen P, Johnsen SP, Strömberg A, Løgstrup BB. Risk factors for hospital readmission in adult patients with heart failure with reduced ejection fraction: A systematic review. JBI Evid Synth. 2020;18(8):1641–700.
24. Lim NK, Lee SE, Lee HY, Cho HJ, Choe WS, Kim H, et al. Risk prediction for 30-day heart failure-specific readmission or death after discharge: Data from the Korean Acute Heart Failure (KorAHF) registry. J Cardiol. 2019;73(2):108–13.
25. Bhosale KH, Nath RK, Pandit N, Agarwal P, Khairnar S, Yadav B, et al. Rate of Rehospitalization in 60 Days of Discharge and It’s Determinants in Patients with Heart Failure with Reduced Ejection Fraction in a Tertiary Care Centre in India. Int J Hear Fail. 2020;2(2):131–44.
26. Cherbi M, Lairez O, Baudry G, Gautier P, Roubille F, Delmas C. Early Initiation of Sodium–Glucose Cotransporter 2 Inhibitors in Acute Heart Failure: A Systematic Review and Meta-Analysis. Vol. 14, Journal of the American Heart Association . 2025.
27. Wang RB, Che M, Yick T, Thomas M, Woldman S, Davies C, et al. Rehospitalisation rates of heart failure patients treated with SGLT2 inhibitors as an inpatient versus post-discharge. Br J Cardiol. 2024;31(3).
28. Hou J, Ren L, Hou Q, Jia X, Mei Z, Xu J, et al. Efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with acute heart failure: a systematic review and meta-analysis. Front Cardiovasc Med [Internet]. 2024;21(1). Available from: https://doi.org/10.3389/fcvm.2024.1388337
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
