Causes and Temporal Patterns of 30‐Day Readmission Among Older Adults Hospitalized With Heart Failure With Preserved or Reduced Ejection Fraction

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> It is unknown whether causes and temporal patterns of 30‐day readmission vary between heart failure (HF) with preserved ejection fraction ( <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> ) and HF with reduced ejection fraction ( <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> ). We sought to address this question by examining a 5% national sample of Medicare beneficiaries. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> We included individuals who experienced a hospitalization for <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> or <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> between 2007 and 2013. We identified causes of 30‐day readmission based on primary discharge diagnosis and further classified causes of readmission as <jats:styled-content style="fixed-case">HF</jats:styled-content> ‐related, non– <jats:styled-content style="fixed-case">HF</jats:styled-content> cardiovascular‐related, and non–cardiovascular‐related. We calculated the cumulative incidence of these classifications for <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> and <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> in a competing risks model and calculated subdistribution hazard ratios of these classifications by comparing those with <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> and those with <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> . Among 60 640 Medicare beneficiaries, we identified 13 785 unique older adults hospitalized with <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> and 15 205 who were hospitalized with <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> . Noncardiovascular diagnoses represented the most common causes of 30‐day readmission ( <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> : 59%; <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> : 47%), a pattern that was observed for each week of the 30‐day study period for both <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> and <jats:styled-content style="fixed-case">HF</jats:styled-content> rEF participants. In comparing readmission diagnoses in an adjusted model, non–cardiovascular‐related diagnoses were more common and <jats:styled-content style="fixed-case">HF</jats:styled-content> ‐related diagnoses were less common in <jats:styled-content style="fixed-case">HF</jats:styled-content> pEF participants. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Non–cardiovascular‐related diagnoses represented the most common causes of 30‐day readmission following <jats:styled-content style="fixed-case">HF</jats:styled-content> hospitalization for each week of the 30‐day postdischarge period. <jats:styled-content style="fixed-case">HF</jats:styled-content> diagnoses were less common among those with <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> compared with <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> . Future interventions aimed at reducing 30‐day readmissions following an <jats:styled-content style="fixed-case">HF</jats:styled-content> hospitalization would benefit from an increased focus on noncardiovascular comorbidity and interventions that target <jats:styled-content style="fixed-case">HF</jats:styled-content> p <jats:styled-content style="fixed-case">EF</jats:styled-content> and <jats:styled-content style="fixed-case">HF</jats:styled-content> r <jats:styled-content style="fixed-case">EF</jats:styled-content> separately. </jats:p> </jats:sec>