Risk factors for hospital readmission in heart failure patients
A new systematic review reveals research gaps and limitations.
Heart failure affects an estimated 26 million people globally. Due to aging populations, a shift toward a Western-style lifestyle (e.g., unhealthy diet, physical inactivity, smoking) and its associated diseases (e.g., diabetes), and improved survival in patients, the prevalence of heart failure is increasing.
Heart failure patients have a high risk of being readmitted to hospital. Readmissions are associated with higher mortality and health care costs. Therefore, it is a high priority to identify vulnerable patients with heart failure who may benefit from targeted personalized care interventions that aim to reduce readmissions.
The systematic review ‘Risk factors for hospital readmission in adult patients with heart failure with reduced ejection fraction’ published in this month’s issue of JBI Evidence Synthesis, summarizes evidence on risk factors for hospital readmission within the first year after hospitalization for heart failure. It provides a comprehensive overview of factors associated with hospital readmission within 30, 60, 90, 180, and 365 days after heart failure hospitalization among patients with heart failure with reduced left ventricular ejection fraction (≤ 40%).
Inge Schjødt from the Department of Cardiology at Aarhus University Hospital, and lead author of the systematic review, explains why the focus of the study was heart patients with reduced ejection fraction.
“We focused our review on patients with heart failure with reduced ejection fraction because diagnosis and treatment are well defined and evidence-based. Additionally, it has been found that patients with reduced ejection fraction have worse prognostic outcomes, which justifies the intensive investigation regarding risk factors in these patients.”
This systematic review differs from previous reviews on the topic: it assesses and provides information on risk factors associated with different readmission measures (all-cause readmission, heart failure readmission, and composite clinical outcomes including readmission) within different timespans in patients with well-defined heart failure, i.e. heart failure with reduced ejection fraction.
“Previous reviews have mainly addressed factors in heterogeneous heart failure populations without distinction between patients with heart failure with reduced, mid-range, and preserved ejection fraction. However, it is considered crucial to differentiate between these three types of heart failure due to different etiologies, characteristics, comorbidity, treatment strategies, and prognosis,” says Schjødt.
The study provides a comprehensive overview of the associations between a range of factors identified and all-cause readmission, heart failure readmission, and composite outcomes within different time intervals after an index hospitalization for heart failure in patients with reduced ejection fraction (left ventricular ejection fraction ≤40%). The results are presented in a highly accessible manner for readers.
“The presence and magnitude of association between each factor identified and outcome of interest are presented in forest plots or tables in the systematic review. Thus, the systematic review provides knowledge that will be readily available to interested readers,” explains Schjødt.
Fifty-two articles were included in the study. There were 128,186 patients with reduced ejection fraction across the studies, ranging from 52 patients to 21,690 patients in a single study. Limitations of the review are related to the quality of the studies included and the different definitions of readmission used. In addition, the heterogeneity of factors investigated and the lack of comparability of findings limit the clinical impact of the identified risk factors in this review. These findings highlight research gaps and the need for a standardized way to define and measure readmission in clinical research to improve study quality and enable comparison of findings between studies.
“There is a need for a standardized way to define and measure all-cause readmission, heart failure readmission, and composite end points in clinical research to improve the quality of studies, enable comparison of findings between studies, and synthesize findings in meta-analyses,” says Schjødt.
The authors’ main recommendations for research concern the definition of the heart failure population, the definition of readmission, and factors to be examined in future studies.
Schjødt says, “Although the clinical implications of this systematic review are limited, this review revealed several important considerations for efforts in future research to improve the quality of studies, enable comparison of findings between studies, and combine findings in meta-analyses from studies investigating factors associated with readmission risk in patients with heart failure with reduced ejection fraction. Furthermore, the knowledge provided about risk factors associated with the three separate readmission outcomes within different timespans may also be useful when planning future studies within this field.”
Schjødt, Inge; Liljeroos, Maria; Larsen, Palle; Johnsen, Søren Paaske; Strömberg, Anna; Løgstrup, Brian Bridal
JBI Evidence Synthesis: August 2020 - Volume 18 - Issue 8 - p 1641-1700
doi: 10.11124/JBISRIR-D-19-00203