Abstract

Background: Readmissions for congestive heart failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E’), during the index admission for CHF could independently predict 30 day readmission.

Methods: This was a single center retrospective cohort study of consecutive CHF patients hospitalized from January 2011 to September 2013. Demographic and clinical variables were obtained and E/E’ measured during the index hospitalization. Patients were then followed for readmission at 30 day. Statistical comparisons were made between readmitted and non-readmitted cohorts.

Results: A total of 212 consecutive patients with a diagnosis of CHF were included in the study. The mean age was 76.6±12.9 vs. 72±12.4 (p=0.64) while mean left ventricular ejection fractions was 0.33±0.14 vs. 0.37±0.15 (p=0.8943) in the readmitted and non-readmitted cohorts respectively. 22.30% of the study patients were readmitted within 30 days of the index hospitalization. The mean E/E’ in the readmitted group was 17.7 compared to 12.81 in the non-readmitted group (p=0.0002).

Conclusion: Elevated Tissue Doppler E/E’ on index admission for CHF is predictive of 30 day readmissions. E/E’ represents a simple, non-invasive tool for identifying CHF patients at highest risk for 30 day readmission.