Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2022; 14(9): 473-482
Published online Sep 26, 2022. doi: 10.4330/wjc.v14.i9.473
Thirty-day readmission in patients with heart failure with preserved ejection fraction: Insights from the nationwide readmission database
Anil Kumar Jha, Chandra P Ojha, Anand M Krishnan, Timir K Paul
Anil Kumar Jha, Internal Medicine, Lowell General Hospital, Lowell, MA 01852, United States
Chandra P Ojha, Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
Anand M Krishnan, Department of Cardiovascular Disease, Larner College of Medicine at the University of Vermont, Burlington, VT 05405, United States
Timir K Paul, Department of Clinical Education, University of Tennessee Health Sciences Center at Nashville, Nashville, TN 37025, United States
Author contributions: All the authors have equally contributed in developing this manuscript.
Institutional review board statement: This study did not require institutional review board approval as de-identified patient records were used.
Informed consent statement: This study did not require informed consent from patients as de-identified patient records were used.
Conflict-of-interest statement: All authors declare no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and data-set available from the corresponding author at Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Anil Kumar Jha, MD, Doctor, Internal Medicine, Lowell General Hospital, 1 Hospital Dr, Lowell, MA 01852, United States.
Received: March 25, 2022
Peer-review started: March 25, 2022
First decision: May 31, 2022
Revised: June 16, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: September 26, 2022

There are rising numbers of patients who have heart failure with preserved ejection fraction (HFpEF). Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies, the management of HFpEF is challenging.


To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.


We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project, Nationwide Readmissions Database for the year 2017. We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF. The primary outcome was the rate of all-cause readmission within 30 d of discharge. Secondary outcomes were cause of readmission, mortality rate in readmitted and index patients, length of stay, total hospitalization costs and charges. Independent risk factors for readmission were identified using Cox regression analysis.


The thirty day readmission rate was 21%. Approximately 9.17% of readmissions were in the setting of acute on chronic diastolic heart failure. Hypertensive chronic kidney disease with heart failure (1245; 9.7%) was the most common readmission diagnosis. Readmitted patients had higher in-hospital mortality (7.9% vs 2.9%, P = 0.000). Our study showed that Medicaid insurance, higher Charlson co-morbidity score, patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates. Lower readmission rate was found in residents of small metropolitan or micropolitan areas, older age, female gender, and private insurance or no insurance were associated with lower risk of readmission.


We found that patients hospitalized for acute or acute on chronic HFpEF, the thirty day readmission rate was 21%. Readmission cases had a higher mortality rate and increased healthcare resource utilization. The most common cause of readmission was cardio-renal syndrome.

Keywords: Heart failure with preserved ejection fraction, Diastolic heart failure, Readmission, National readmission database, Health care resource utilization

Core Tip: Our study highlights the current trend in heart failure with preserved ejection fraction (HFpEF) readmissions, and important causes and predictors of readmissions. It also highlights that mortality in readmission is greater compared to index admissions. The economic burden of HFpEF is also highlighted.