Assessment of Discharge Readiness and Readmission Risk in Patients With Acute Decompensated Heart Failure

Failure to achieve euvolemia before discharge in patients admitted with acute heart failure (HF) syndromes has gained attention as a marker for increased readmission risk. This study assessed whether variations in discharge documentation practices reflected the readmission risk of patients admitted for decompensated HF. This was a retrospective cohort study of 100 adult patients discharged from an admission for an acute HF syndrome from May 2014 to June 2015. Characteristics at discharge were retrieved from the discharge summaries (DS). Coprimary outcomes were 30-day and 6-month composites of all-cause readmissions or emergency department visits. Mean age was 62.1 years (SD 15.3), and 56% were men. Traditional cardiovascular risk factors were common. All-cause 30-day readmission occurred in 18%, and HF-related 30-day readmission occurred in 12% of the population. A DS physical exam in support of decongestion occurred more often in those not readmitted, for example, a normal jugular venous pulse (53.2 vs 12.5 %, p = 0.03). Discussion of jugular venous pulse improvement occurred more frequently in those not readmitted (8.5 vs 0%, p = 0.03). No other markers of volume status reached statistical significance. A clear statement in the DS supporting euvolemia was uncommon, but tended to occur more commonly in those not readmitted (20.7 vs 5.6%, p = 0.13). In conclusion, documenting markers of euvolemia and incorporating these markers into the DS volume status assessment was associated with a reduced rate of 30-day readmission. (C) 2018 Elsevier Inc. All rights reserved.