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Discharge disposition and 1-year readmission in acute-phase hospitalized patients with heart failure: a retrospective observational multi-center study

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Abstract

Patients hospitalized for acute heart failure (HF) tend to experience declines in physical function and activities of daily living (ADL) due to bed rest and restricted mobilization. This could result in some patients being transferred to rehabilitation hospitals. This study aims to examine the relationship between discharge disposition and 1-year readmission and mortality rates in HF patients. Nine hundred fifty six consecutive HF patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into two groups: home (returned home) or transfer (transferred to rehabilitative or long-term care hospital units due to decline in physical function and/or ADL) groups. The primary and secondary outcomes were 1-year readmission and mortality rates after discharge, respectively. Of the 956 patients, 8.6% (n = 82) were transferred to rehabilitative or long-term care hospital units. Over a 1-year follow-up period, all-cause and HF readmission rates were 50.1% (n = 479) and 27.2% (n = 260), respectively. The transfer group had significantly lower readmission rates compared to home group after adjusting for the pre-existing risk factors (hazard ratio for all-cause and HF readmission: 0.600 and 0.552, 95% CI 0.401–0.897 and 0.314–0.969; P = 0.013 and P = 0.038, respectively). There was no significant relationship between discharge disposition and all-cause mortality rate. Low ADL defined as Barthel index < 60 points was identified as a predictor of all-cause and HF readmission among the home group (odds ratio for all-cause and HF readmission rates: 2.156 and 1.847, 95% CI 1.026–4.531 and 1.036–2.931; P = 0.043 and P = 0.037, respectively). This multi-center study demonstrated that HF patients transferred to rehabilitative or long-term care hospital units after an acute hospitalization had a significantly decreased 1-year all-cause and HF readmission rates compared to patients who returned to their home. These findings may help in selecting a discharge disposition for older HF patients with ADL decline.

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Acknowledgements

We thank all staff of the participating hospitals, Shizuoka Medical Center, Juntendo University Shizuoka Hospital, Shizuoka City Hospital, Fujinomiya City General Hospital, and Hamamatsu University Hospital, for facilitating this multi-center study. We also thank Fumi Nihei Green and Akira Kubo for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, 1-30 Mizuochi-cho, Aoi-ku, Shizuoka, Shizuoka, 420-0831, Japan

    Michitaka Kato

  2. Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan

    Yuji Mori & Kazuya Kito

  3. Department of Rehabilitation, Juntendo University Shizuoka Hospital, Shizuoka, Japan

    Daisuke Watanabe

  4. Department of Rehabilitation, Shizuoka City Hospital, Shizuoka, Japan

    Hiroshige Onoda

  5. Department of Rehabilitation, Fujinomiya City General Hospital, Shizuoka, Japan

    Keita Fujiyama

  6. Department of Rehabilitation, Hamamatsu University Hospital, Shizuoka, Japan

    Masahiro Toda

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  1. Michitaka Kato
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Correspondence to Michitaka Kato.

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Kato, M., Mori, Y., Watanabe, D. et al. Discharge disposition and 1-year readmission in acute-phase hospitalized patients with heart failure: a retrospective observational multi-center study. Heart Vessels 37, 1551–1561 (2022). https://doi.org/10.1007/s00380-022-02059-2

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