Abstract
Despite ongoing efforts, heart failure hospitalization (HFH) rates remain high. The underserved population may be at higher risk for readmission given limited access to health care professionals, advanced device-based therapies, and newer medications. The goal of the current study was to determine HFH rates in an urban Safety-Net hospital and to identify clinical and non-clinical factors that may influence these rates.
All patients > 18 years of age admitted to the Coronary Care Unit from March 2017 to February 2018 at Los Angeles County USC Medical Center were indexed in a database. Demographics, insurance status, history of drug use, ejection fraction (EF), etiology of heart failure, treatment received, and length of hospital stay were collected. All-cause and 30-day HFH rates were determined.
During the study period, 188 patients were identified. Mean age was 58±14 years, 69% were male, 15% had preserved EF, and 35% had an ischemic cardiomyopathy. The prevalence of active tobacco/alcohol use was 42%. Active use of methamphetamines, heroin, cocaine, and/or cannabis was present in 18%. HFH at 30 days for the entire cohort was 17%. Length of hospital stay was 4.2±5.1days. Following the index hospitalization, only 45% of patients returned for a scheduled follow-up outpatient visit. On univariate analysis, current drug use, current alcohol/smoking, and homelessness were associated with an increased HFH rate within 30 days. On multivariate analysis, homelessness was the only independent risk factor associated with HFH (p=0.049).
Homeless individuals have a significantly increased risk for heart failure hospitalization. Additional interventions focused on improving post-discharge outpatient follow-up rates, targeting continued drug use, and facilitating adequate housing are required in the underserved population.
