Assessment of Hospital Readmission Rates, Risk Factors, and Causes After Cardiac Arrest

This cohort study investigates the rate, timing, and causes of hospital readmission after cardiac arrest and the risk factors associated with readmission.


Introduction
Cardiac arrest (CA) remains a global health challenge with high rates of mortality and morbidity. 1,2 Furthermore, recovery from CA without residual neurologic deficit is limited. Consequently, the burden of CA on the US health care system is increasing.
Thirty-day readmissions are costly and associated with poor outcomes. 3 However, there is a paucity of data regarding the readmission characteristics of CA, and previous studies have mostly focused on older populations. 4 Therefore, further understanding of readmission after CA is needed to allow institutions to focus already limited resources and prevent unnecessary readmissions. We aimed to investigate contemporary rate, timing, causes, and risk factors associated with 30-day readmissions after CA.

Methods
This cohort study used data from the Nationwide Readmissions Database (NRD) from 2010 to 2014.
Data analysis was performed from January 1, 2010, to November 30, 2014. The NRD collects annual discharge data and enables nationally representative readmission analyses. 5
Author affiliations and article information are listed at the end of this article.
Overall, approximately three-quarters (72.1%) of the 30-day readmissions were due to noncardiac causes, which were more common among patients with pulseless electrical activity or asystole than those with ventricular tachycardia or ventricular fibrillation (77.2% vs 61.4%; difference, 15.7%; 95% CI, 14.9%-16.6%; P < .001). Among noncardiac causes, infectious etiology (pneumonia and sepsis) was most prevalent (18.9%), followed by chronic obstructive pulmonary disease or respiratory failure (13.3%). Heart failure and arrhythmia accounted for more than 50% of all cardiac causes of readmission. After adjusting for baseline characteristics, several comorbidities were independently associated with a higher risk of 30-day readmission across the rhythm cohorts ( Table 2).

Discussion
Given the high readmission rates and substantial economic burden associated with CA, nationwide efforts are necessary to develop strategies designed explicitly for CA survivors to reduce preventable readmissions. Of those readmitted within 30 days, more than half were readmitted within 9 days, especially for noncardiac causes. Close outpatient follow-up during the first 10 days after hospitalization may be an opportunity for clinicians to preemptively intervene on any evolving medical conditions and consequently prevent readmissions for CA survivors. 6 Furthermore, patients with limited access to health care owing to their socioeconomic status have been shown to use the emergency department more as a primary source of care, which may lead to more readmissions.
Therefore, multidisciplinary efforts to support the transition from inpatient to outpatient care with a readily available support system, including proper patient education, follow-up telephone calls, use of remote telemonitoring, clinician home visits, and postdischarge hotlines are potential strategies to