Author + information
- Jason Lappe,
- Jeffrey Anderson,
- Abdallah Kfoury,
- Donald Lappe,
- Kimberly Brunisholz,
- J. Muhlestein,
- Heidi May and
- Benjamin Horne
The red cell distribution width (RDW) predicts mortality and other major adverse events, including incident heart failure (HF). New Medicare penalties on hospitals for worse-than-expected 30-day readmission of HF patients requires adequate anticipation of who is most at risk. This study evaluated whether the RDW predicts 30-day readmission (all-cause and HF-specific) among HF patients.
All patients with a primary ICD-9 discharge diagnosis of HF at Intermountain Healthcare during 1999-2011 were studied. Intermountain's electronic medical records were queried for age, sex, complete blood count (CBC), and basic metabolic profile (BMP), with. Hospital readmission and mortality within 30 days of discharge were also queried, and death data were supplemented with Utah death certificates and Social Security death records. Analysis used Cox regression adjusted for age, gender, and other CBC and BMP components.
HF patients (N=6,616) averaged 71.4±14.6 years of age and 52.3% were female. At 30 days of follow-up, 737 patients were readmitted (244 for a HF diagnosis) and 329 patients died. After full adjustment, continuous RDW values predicted 30-day all-cause readmission risk (hazard ratio [HR]=1.047 per +1% of RDW, 95% CI=1.01, 1.08; p=0.007). HF-specific readmission was better predicted by RDW (HR=1.060 per +1%, CI=1.003, 1.12; p=0.040), but the association with mortality was even stronger (HR=1.111 per +1%, CI=1.06, 1.16; p<0.001). Recursive partitioning of RDW for readmission found adjusted HR=1.36 (p=0.16) for RDW=12.9%-15.8% compared to <12.9%, HR=1.60 (p=0.035) for 15.9%-20.2% vs. <12.9%, and HR=1.93 (p=0.010) for ≥20.3% vs. <12.9%. For HF-specific readmission, those thresholds had adjusted HR=2.13, 2.67, and 3.88, respectively, and for death had HR=1.21, 2.39, and 2.39.
The RDW significantly predicted 30-day hospital readmission, and did so especially well for HF readmission. RDW also strongly predicted 30-day mortality. The RDW may be useful in risk-stratifying HF patients and focusing advanced care to prevent readmission and the related reimbursement penalties.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Lessons Learned from Acute Decompensated Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1175-278
- 2013 American College of Cardiology Foundation