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Heart failure readmissions are the focus of many quality improvement projects nationwide and will play a large part in reimbursements. Socioeconomic differences between urban and suburban patients presenting to the same hospital system may play a role in readmission rates. We hypothesize that readmission rates are higher with urban patients than suburban patients.
All patients presenting with an admission diagnosis of heart failure to a tertiary urban medical center from July 2008 to December 2011 were included in the study. Readmission was defined as being admitted to the hospital within 30 days of a previous heart failure admission. A retrospective chart review was conducted and average household income was identified for each patient zip code. Patients living in Camden, New Jersey (urban) were compared to patients in neighboring suburban communities.
The study period had 3,755 admissions for heart failure of which 476 (12.7%) were readmissions within 30 days. The urban group as compared to the suburban group had a lower mean age (66.2 vs 70.2 years, p<0.01), had a greater percentage of Black patients (63.8% vs 29.8%, p< 0.001), but equivalent percentage females (46.9 vs 44.9, p=0.245).
The urban group as compared to suburban group had statistically higher mean heart rate and blood pressure although left ventricular ejection fraction (LVEF), serum sodium, and blood urea nitrogen (BUN) were equivalent. The urban population accounted for 893 admissions (23.8%) with a mean income level of $22,769. The suburban population accounted for 2,861 admissions (76.2%) with a mean income of $49,046. Urban population had a readmission rate of 18.9% as compared to a suburban readmission rate of 10.7% (p < 0.001).
Our single center, retrospective study shows that there is a significantly elevated readmission rate in an urban population with lower income levels compared to a suburban population that present to the same hospital. Although severity of heart failure were similar between populations as based on mean LVEF, sodium, and BUN, the urban population has higher heart rate and blood pressures which may represent under treatment with medication regimens.
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: 1175-279
- 2013 American College of Cardiology Foundation