Temporal distribution of 6-month adverse events following hospital discharge for heart failure
I Moseley, A CorreaAbstract
Background/Introduction
The period immediately after discharge from a hospital admission for heart failure is considered a vulnerable phase of care. However, the relative contribution of early versus later post-discharge events to overall medium-term risk has not been well described.
Purpose
To quantify the proportion of 6-month post-discharge adverse events attributable to the first 30 days after hospital discharge for heart failure.
Methods
Hospital admissions with a primary diagnosis of heart failure were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a publicly available, de-identified electronic health record resource. Adult patients with an index admission for heart failure and discharge alive were included, and repeat admissions were excluded from index designation. Heart failure diagnoses were identified using International Classification of Diseases coding. The primary outcome was a composite of all-cause death or heart failure readmission within 180 days after discharge. Events were classified as early (0–30 days) or later (31–180 days). The cumulative incidence of early and later events and the proportion of total 6-month events occurring in each period were calculated.
Results
A total of 2 008 index hospitalizations for heart failure met inclusion criteria. The composite outcome occurred in 41.3% of patients within 6 months. Early events occurred in 172 patients (8.8%), while an additional 639 (32.7%) experienced events between 31 and 180 days. Overall, 21.3% of all composite events within 6 months occurred during the first 30 days after discharge, indicating a concentrated early period of vulnerability for adverse outcomes.
Conclusion(s)
More than one-fifth of adverse events within 6 months of discharge following hospitalization for heart failure occurred in the first 30 days. These findings support the concept of an intensified early vulnerability period and underscore the potential value of structured transitional care, early follow-up strategies, and medium-term risk mitigation beyond conventional 30-day metrics. A focus solely on early readmissions may underestimate the broader burden of post-discharge adverse events.For image description, please refer to the figure legend and surrounding text.