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case-control studies, frail elderly, heart failure, hospital readmission



  1. Eastwood, Cathy A. RN, PhD
  2. Quan, Hude MD, PhD
  3. Howlett, Jonathan G. MD
  4. King-Shier, Kathryn M. RN, PhD


Background: Rehospitalizations within 7 days after discharge may reflect the quality of hospital care.


Objective: We examined factors associated with 7-day readmissions after discharge for heart failure (HF).


Methods: Using a matched pair case-control design, we examined health records for sociodemographic, clinical, and health system factors for patients with a primary diagnosis of HF (ICD-10 I50) discharged alive from all acute care hospitals in Calgary, Alberta, from 2004 to 2012. Logistic regression was used to identify variables associated with 7-day all-cause readmission.


Results: We included 382 patients, or 191 in matched pairs, with 41% of readmissions due to HF. Frailty (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.41-3.76) and attending physician as specialist (aOR, 2.10; 95% CI, 1.32-3.42) were associated with increased likelihood of readmission. Reduced likelihood of readmission was associated with documented instructions for follow-up with a family physician within 1 week of discharge (aOR, 0.56; 95% CI, 0.36-0.88). All 3 factors were easily abstracted from all patient records, including frailty, which was defined as all 3 of age older than 75 years, 3 or more comorbid conditions, and requiring assistance with activities of daily living.


Conclusion: Very early readmission to hospital after HF admission is associated with 3 factors that may be easily identified in patient records.