Pregnancy-related Heart Failure Readmissions in the US: Analysis of the Nationwide Readmissions Database

ABSTRACT Background Cardiovascular disease (CVD) is the leading cause of pregnancy-related morbidity and mortality in the United States. Several studies have evaluated readmission rates in the general HF population, but in patients with pregnancy-related HF, readmissions have been understudied. This study aims to characterize the 30-day HF readmission patterns in pregnancy-related admissions to identify vulnerable patient populations. Methods The National Readmission Database from 2016 to 2021 was used to identify women aged 13-49 with an index hospitalization in which HF was coded as either the primary or secondary diagnosis during a pregnancy-related antepartum, delivery, or postpartum admission, identified by diagnosis-related group (DRG) codes and ICD-10 codes. The primary outcome was 30-day all-cause readmission. We performed descriptive and comparative analyses to describe the differences in patient characteristics and readmission patterns between groups. Results The overall 30-day all-cause readmission rate was 13% when readmissions for delivery were excluded. The readmission rate increased with age, peaking at 15.1% in the 38-49yr age group. Higher readmission rates were also associated with combined (systolic and diastolic) HF (16.1%), systolic HF (14.8%), lower socioeconomic status (15.3%), substance use disorder (17.2%), and alcohol use (18.6%). Patients whose index hospitalization was for delivery had the highest absolute risk of 30-day readmission at 19.3%. Readmissions peaked between days 6 and 8 post discharge, with more than 50% of all readmissions occurring within the first two weeks post-discharge Conclusions In our study, the highest risk of readmission occurred after an index hospitalization for delivery, and most readmissions occurred in the first 2 weeks post-discharge. Our findings suggest that a post-discharge follow up within 7 days of admission complicated by HF should be extended to patients with pregnancy-related HF and effective readmission reduction strategies must include a better understanding of heart failure phenotypes, and a proactive approach to addressing social risk factors.