Heart failure readmissions in urban and rural hospital settings: An analysis of 30-day readmissions using the 2021 Nationwide Readmissions Database.

Rural hospitals had lower overall odds of 30-day heart failure readmission compared to urban hospitals.

• Analysis used the 2021 Nationwide Readmissions Database with adults hospitalized with a primary diagnosis of heart failure.
• Hospital rural-urban classification was based on the Urban-Rural Classification Scheme (HOSP_URCAT4) provided by the Healthcare Cost and Utilization Project.
• Weighted multivariable logistic regression with interaction terms was used to assess geographic variation in readmission risk.
• The primary outcome was the first non-elective inpatient admission for heart failure occurring within 30 days of discharge from an index hospitalization.

Among rural patients, those with no-charge hospitalizations had the highest risk of 30-day readmission, followed by self-pay patients.

• Rural patients with no-charge hospitalizations had an adjusted odds ratio of 1.830 (95% CI [1.059, 3.161]).
• Rural patients with self-pay status had an adjusted odds ratio of 1.301 (95% CI [1.143, 1.480]).
• This pattern differed from the overall lower readmission odds observed at rural hospitals, indicating the lower rural readmission rate did not extend to self-pay or no-charge patients.
• Interaction terms between geographic location and insurance payer type were included in the multivariable model.

Diabetes, COPD, and longer hospital stays were significant clinical predictors of 30-day heart failure readmission.

• Diabetes was associated with increased readmission risk (aOR = 1.181).
• COPD was associated with increased readmission risk (aOR = 1.258).
• Longer hospital stays were associated with increased readmission risk (aOR = 1.246).
• These covariates were included alongside age, sex, discharge disposition, insurance payer type, median household income, hospital bed size, teaching status, geographic location, and total charges.

Private insurance and higher median household income were protective against 30-day heart failure readmission.

• Private insurance was associated with lower readmission odds (aOR = 0.684).
• Higher median household income was associated with lower readmission odds (aOR = 0.917).
• These findings highlight socioeconomic factors as determinants of readmission risk in heart failure patients.

The predictive model for 30-day heart failure readmission demonstrated modest performance.

• The area under the curve (AUC) was 0.589.
• The Brier score was 0.167.
• The model used weighted multivariable logistic regression with interaction terms.

Rural populations with heart failure experience higher mortality and fragmented care, yet limited research has explored geographic variation in readmission predictors.

• Heart failure is described as a leading cause of hospital readmissions in the United States.
• The study was designed to examine how demographic, clinical, structural, and socioeconomic factors influence 30-day readmission risk across geographic locations.
• This was a secondary analysis of the 2021 Nationwide Readmissions Database.