A Five-year Analysis Of Trends, Readmission, And Clinical Outcomes In Hospitalized Heart Failure Patients With Reduced Ejection Fraction And Obstructive Sleep Apnea: Insights From The National Readmission Database

• Published in: Journal of cardiac failure 2024-01, Vol.30 (1), p.232-232
• Main Authors: Bolaji, Olayiwola, Shah, Rajendra, Nair, Ambica, Adabale, Olanrewaju, Oeudraogo, Faizal, Ebubechukwu, Ugochukwu, Antia, Akanimo, Tsou, Han Chen Tom, Pius, Ruth, Evbayekha, Endurance, Batulia, Anusha, Alraies, M Chadi
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.276

Heart failure with reduced ejection fraction (HFrEF) is a significant health concern that often leads to recurrent hospitalizations. Comorbid obstructive sleep apnea (OSA) has been linked to poor outcomes and an increased risk of cardiovascular mortality, mainly if not adequately managed. Numerous studies have investigated in-hospital outcomes for patients admitted with HFrEF. However, the determinants, trends, burdens, and outcomes of 30-day readmissions in patients hospitalized with HFrEF and OSA as comorbidity remains unclear. We conducted a retrospective analysis of the National Readmission Database(NRD) from 2016 to 2020 to identify patients diagnosed with HFrEF and OSA using validated ICD codes. Case fatality rate during the index admission, readmission rate, etiologies of readmission, and predictors of readmission were evaluated. Our analysis included 926,102 patients with HFrEF and OSA. The case fatality rate during index admission was 3.41%, while the 30-day readmission rate was 10%. Cardiac-related etiologies accounted for over 60% of all readmissions. Sepsis, acute kidney injuries, and chronic obstructive pulmonary disease were among the most prevalent non-cardiac-related causes of readmission throughout the 5-year study period. After adjusting for relevant covariates, the independent predictors of increased 30-day readmission after discharge included non-ST elevation myocardial infarction(NSTEMI) (OR 1.37, 95% CI 1.30-1.36), Length-of-Stay(LOS) less than three days (OR 1.10, 95% CI 1.07-1.15), and sepsis (OR 1.11, 95% CI 1.08-1.14). While factors associated with a decreased likelihood of 30-day readmission were depression (OR 0.66, 95% CI 0.63-0.67) and atrial fibrillation (OR 0.74, 95% CI 0.72-0.77). Our study demonstrated that patients with HFrEF and OSA face a significant risk of 30-day readmission, with cardiac-related etiologies constituting over 60% of these readmissions. Independent predictors of increased readmission include NSTEMI, LOS of less than three days, and sepsis. In contrast, depression and atrial fibrillation were associated with a decreased likelihood of 30-day readmission. Further studies are needed to evaluate how these factors affect the readmission rate, targeted interventions, and enhanced management strategies to alleviate the readmission burden.