Diverse reasons for high early hospital readmission burden following discharge from a heart failure virtual ward: insights from a retrospective cohort study
A Sidhu, K Pattenden, C Screeche-Powell, F Windsor, G D Cole, C Barton, D Auger, C Plymen, S ZamanAbstract
Background
Heart Failure (HF) is a leading cause of unplanned hospital admission (1). Virtual Wards (VWs) for HF facilitate early discharge or admission avoidance through remote monitoring and community care (2). Reported rates of hospital readmission in the early period after VW discharge are variable (3). Data from our centre indicate that over a quarter of patients are readmitted within 30 days of VW discharge. The clinical and operational impact of these early readmissions may be substantial (4); but why they occur is not well described (5). We evaluated the causes of early hospital readmission after discharge from a HF VW that uses smartphone-based remote monitoring, but without the capability for home intravenous (IV) diuretics.
Purpose
To evaluate the causes of early hospital readmission within 30 days of discharge from a HF VW. To identify drivers of readmission and inform future service development.
Methods
In this subgroup analysis of a retrospective cohort study, we identified 150 consecutive patients onboarded to the VW between January and December 2024. From these, patients with an inpatient hospital stay of at least 1 day immediately preceding VW admission were identified. Hospital readmissions (any cause) occurring directly from the VW or within 30 days of discharge were evaluated. Data extracted from the electronic patient record included reason for readmission, length of stay (LoS) on the VW, preceding hospital stay, subsequent readmission LoS, and inpatient treatments administered. Reasons for readmission were categorised at a consensus meeting of heart failure clinicians.
Results
93 out of 150 (62.0%) patients were onboarded to the VW following an inpatient stay of more than 1 day. Of these, 24 patients (25.8%) were readmitted to hospital within 30 days of VW discharge. Patients spent an average of two weeks on the VW and the preceding hospital stay was comparable to national registry data (8 days) (6). All patients received treatment related to acute HF during readmission, even if HF was not the primary readmission reason. Readmissions were categorised as ‘primarily cardiovascular’ (15 patients; 62.5%) and ‘primarily non-cardiovascular’ (9 patients; 37.5%). Subcategories are shown in Figure 1.
Conclusions
The high rate of readmissions after VW discharge was often driven by fluid overload without a clear secondary precipitant. This may be reduced by access to home IV diuretic therapy alongside the VW. Many patients were readmitted directly from the VW due to early detection of cardiac emergencies, which may be an additional benefit of VW monitoring. Over 1/3 readmissions were due to non-cardiovascular causes, highlighting the importance of a multidisciplinary VW model with general nursing as the first point of contact, supported by specialist input. Further randomised studies are needed to better characterise the mechanism of early readmissions, and the operational costs of increased clinical vigilance in virtual care models.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.