Temporal Trends And Predictors Of Poor Outcomes In Right Heart Failure Hospitalizations: Insights From The National Readmission Database

Background Right Heart Failure (RHF) is a complex and diverse syndrome that confers a high risk of morbidity and mortality. Objective: We sought to study predictors of poor outcomes associated with RHF. Methods The study is a retrospective analysis of the National Readmission Database (NRD) of years 2017-2019 which is the largest publicly available all-payer inpatient readmission database in the US. International Classification of Disease Clinical Modification 10th Revision (ICD-10-CM) codes specific for RHF were introduced in October 2017. Our cohort was adult admissions with a primary diagnosis of RHF. December discharges of each year were excluded from the analysis to allow 30-day follow-up. Admissions with RHF as a secondary diagnosis were also excluded. The cohort was divided into 3 groups; group 1: Isolated RHF, group 2: combined RHF and left side heart failure with reduced ejection fraction (HFrEF), and group 3: Combined RHF and heart failure with preserved ejection fraction (HFpEF). Group 1 was used as a reference group to create 2 sets of analyses; analysis 1: Group 1 Vs. Group 2, and analysis 2: Group 1 Vs. Group 3. A series of multivariate logistic regression was performed to calculate the adjusted odds ratio (aOR). Outcomes evaluated were temporal trends in RHF diagnosis, in-hospital mortality, and 30-day all-cause readmissions. Results A total of 127,503 RHF admissions were identified from the database. There was a trend of increasing RHF diagnosis from 2017 4th Quarter to 2019 4th Quarter (130 to 171 RHF per 100,000 admissions, Ptrend<0.001) (Figure 1). Our cohort included 4755 primary RHF admissions of whom 3877 in group 1, 338 in group 2, and 540 in group 3. Baseline characteristics are outlined in table 1. In analysis 1, isolated RHF was associated with lower in-hospital mortality compared to the combined RHF/HFrEF group despite similar 30-day readmissions. In analysis 2, no difference was seen in both outcomes (Table 2). Predictors of in-hospital mortality in the main cohort were female sex, age, liver disease, and sepsis (P<0.05). Conclusion There has been increasing recognition of RHF diagnosis from 2017 to 2019 in the US. Patients with RHF and HFrEF are at a higher risk for in-hospital mortality than patients with isolated RHF despite having a similar 30-day readmission rate. Further studies are needed to validate these preliminary findings. Right Heart Failure (RHF) is a complex and diverse syndrome that confers a high risk of morbidity and mortality. Objective: We sought to study predictors of poor outcomes associated with RHF. The study is a retrospective analysis of the National Readmission Database (NRD) of years 2017-2019 which is the largest publicly available all-payer inpatient readmission database in the US. International Classification of Disease Clinical Modification 10th Revision (ICD-10-CM) codes specific for RHF were introduced in October 2017. Our cohort was adult admissions with a primary diagnosis of RHF. December discharges of each year were excluded from the analysis to allow 30-day follow-up. Admissions with RHF as a secondary diagnosis were also excluded. The cohort was divided into 3 groups; group 1: Isolated RHF, group 2: combined RHF and left side heart failure with reduced ejection fraction (HFrEF), and group 3: Combined RHF and heart failure with preserved ejection fraction (HFpEF). Group 1 was used as a reference group to create 2 sets of analyses; analysis 1: Group 1 Vs. Group 2, and analysis 2: Group 1 Vs. Group 3. A series of multivariate logistic regression was performed to calculate the adjusted odds ratio (aOR). Outcomes evaluated were temporal trends in RHF diagnosis, in-hospital mortality, and 30-day all-cause readmissions. A total of 127,503 RHF admissions were identified from the database. There was a trend of increasing RHF diagnosis from 2017 4th Quarter to 2019 4th Quarter (130 to 171 RHF per 100,000 admissions, Ptrend<0.001) (Figure 1). Our cohort included 4755 primary RHF admissions of whom 3877 in group 1, 338 in group 2, and 540 in group 3. Baseline characteristics are outlined in table 1. In analysis 1, isolated RHF was associated with lower in-hospital mortality compared to the combined RHF/HFrEF group despite similar 30-day readmissions. In analysis 2, no difference was seen in both outcomes (Table 2). Predictors of in-hospital mortality in the main cohort were female sex, age, liver disease, and sepsis (P<0.05). There has been increasing recognition of RHF diagnosis from 2017 to 2019 in the US. Patients with RHF and HFrEF are at a higher risk for in-hospital mortality than patients with isolated RHF despite having a similar 30-day readmission rate. Further studies are needed to validate these preliminary findings.