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Background: Left atrial hypertension results in pulmonary hypertension which is a frequent finding in the setting of left ventricular failure. We hypothesized that noninvasive measurement of systolic pulmonary artery pressure (SPAP) by echocardiography could be used to estimate the risk of hospital readmission in patients with congestive heart failure (CHF). Methods: We conducted a retrospective cohort study on patients discharged from a major urban hospital between June 2009 and October 2009 with a primary diagnosis of CHF. Noninvasive assessment of SPAP by 2D echocardiography performed within 6 months preceding hospital discharge was among the inclusion criteria. A SPAP of 40 mmHg or greater in addition to other factors potentially predictive of re-hospitalization were included in a univariable cox-regression analysis for predicting all-cause readmission. Variables with p-values less than 0.25 were allowed to participate in a stepwise cox-regression model which identified all statistically significant predictors within a mutlivariable setting. Results: 145 patients participated in the stepwise cox-regression analysis. The mean SPAP (mmHg) was 47 with a median of 46. The following statistically significant predictors were identified: hemoglobin nadir < 10 g/dl (HR 1.63; 95% CI 1.07-2.48; P = 0.02), requirement of skilled nursing care after discharge (HR 1.73; 95% CI 1.14-2.63; P = 0.011), diagnosis of COPD (HR 1.62; 95% CI 1.04-2.51; P = 0.03), diagnosis of ESRD (HR 2.05; 95% CI 1.18-3.55; P = 0.01), use of cardiac resynchronization therapy (HR 4.71; 95% CI 1.95-11.35; P < 0.001) and SPAP of 40 or above (HR 2.03; 95% CI 1.30-3.18; P = 0.002). Conclusions: Previous limited studies have suggested that pulmonary hypertension is a prognostic marker in patients with cardiomyopathy. Our data suggests that noninvasive measurement of SPAP by echocardiography can help to predict the risk of hospital readmission in patients hospitalized for CHF. A systolic PAP of 40 mmHg or above appears to be a stronger predictor of re-hospitalization when compared to traditional risk factors including COPD, ESRD and anemia.

Background: Readmission within 30 days of a prior hospitalization for congestive heart failure (CHF) has emerged as a major marker of quality improvement and payment reform. Whereas a number of interventions are available to improve outcomes and reduce readmission rates, there remains an urgent need for accurate risk stratification tools that could be used to build cost-effective and personalized CHF management programs. Methods: We conducted a retrospective cohort study on patients discharged from a major urban hospital between June 2009 and October 2009 with a primary diagnosis of CHF. Patients were followed until their first all-cause hospital readmission. We made minor modifications to 4 different readmission risk scores in order to assess and compare their ability to estimate the risk of hospital readmission at 30 days from discharge. Three of the scores (Chin and Goldman 11 point scoring, Philbin and DiSalvo 15 point scoring and Krumholz et al 4 point scoring) were retrieved from reviewing the literature. The fourth tool (Henry Ford score) is an internal non-validated computed calculator based on 8 predictive factors, previously derived within our institution. The scores were compared by logistic regression and area under the ROC curve. Results: 285 patients were included in the study. The readmission rate at 30 days was 23.5% (67 of 285). A logistic regression revealed that both Chin and Goldman and Philbin scores were poor and statistically non-significant predictors of 30-day all-cause readmission (p-values = 0.784 and 0.165 respectively). When compared by logistic regression and area under the ROC curve, Henry Ford tool (p-value = 0.003; AUC = 0.64) performed the best followed by the Krumholz score (p-value = 0.017; AUC = 0.60). Conclusions: In an era where there is an urgent need to improve and personalize heart failure management programs, simple scores can be used to stratify patients according to their risk of re-hospitalization. Krumholz and Henry Ford scores are both accurate tools for the prediction of 30-day all-cause readmission. Krumholz score relies on 4 easily retrievable risk factors while the Henry Ford tool is a computed model that integrates 8 different factors.

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