Association between Severity of Anemia and 30-Day Readmission Rate: Archival Data of 847 Patients with Acute Decompensated Heart Failure

Hospitals today are facing adjustments to reimbursements from excessive readmission rates. One of the most common and expensive causes of readmissions is exacerbation of a heart failure condition. The objective of this paper was to determine if there was an association between the presence of anemia in patients with acute decompensated heart failure and their readmission rate. Using archival data of 4 hospitals in the Miami area, a sample of 847 inpatients with a diagnostic related group (DRG) of HF at discharge was considered. There was a significant association between low hemoglobin values and a high rate of readmissions at 14 days and at 30 days in subjects with normal sodium and creatinine values. For subjects with low sodium and high creatinine values, a higher readmission rate was seen in men with low hemoglobin but not in women. These results support a prospective effort to measure the impact of anemia and its treatment on readmission rates. 1. Introduction Readmission within 30 days of a hospitalization discharge is a popular topic in current healthcare as the Centers for Medicare and Medicaid Services are targeting readmission rates to reduce costs. In 2007, the Medicare Payment Advisory Commission (MedPac) identified seven conditions and procedures that accounted for almost 30% of potentially preventable readmissions [1]. Nationally, the population with a diagnosis of chronic heart failure (HF) constitutes one of the highest risk populations for readmissions within 30 days of a hospitalization and HF is the most common cause of preventable readmission [2]. Specifically, individuals with HF are most often readmitted with acute decompensated heart failure (ADHF) which is a sudden or gradual onset of heart failure symptoms [3]. The balance between payment penalties and restructuration of policies to reduce readmission rates has been discussed at length and yet there is a lack of discussion about best practices. Are readmissions of patients with heart failure (HF) preventable, and, if so, can simple integrated approaches help reduce this readmission rate? Mazimba et al. [4] found that, with the exception of the left ventricular ejection fraction, the traditional performance measures in HF (like smoking cessation, the use of ACE inhibitors, the measure of the left ventricular ejection fraction, and discharge instructions) were poorly associated with the readmission rate in the HF population. Anemia is a common comorbidity in patients with HF, being diagnosed in roughly 30% of nonhospitalized and nearly 50% of hospitalized HF patients [5]. During a