Abstract 14189: Household Income and Trends in 30-day Readmission for Patients With Heart Failure

Introduction: The relationship between household income and trends in 30-day readmission among patients with heart failure (HF) is unknown. Further, whether the hospital readmission reduction program (HRRP) had differential associations with HF readmissions among patients with lower versus higher household income is unclear. Methods: The National Readmission Database (NRD) was examined to identify all admissions among adults with a primary diagnosis of HF who had at least one unplanned readmission within 30 days between 2010-2019. Median household income by patient zip code was assessed as quartiles: low income, middle income, upper-middle income, and high income. Yearly trends in adjusted all-cause 30-day readmission rates were assessed by household income quartile. Adjusted readmission rates were compared for the pre-HRRP period (2010-2012) vs. post-HRRP period (2013-2019). Results: Among 9,020,742 index hospitalizations between 2010-2019, adjusted all-cause 30-day readmission rates increased for patients in low-income (18.8% to 19.0%, P trend <0.001) and middle-income quartiles (17.6% to 17.9%, P trend <0.001), remained similar in the upper-middle income quartile (17.7% to 17.3%, P trend 0.24), and decreased in the high-income quartile (16.8% to 16.4%, P trend 0.039) (Figure, Panel A). Associations between HRRP and average adjusted all-cause readmission varied by income quartile, such that greater increases in readmissions were seen among patients in lower quartiles (p for interaction <0.001). ( Figure, Panel B) . Conclusions: Among patients hospitalized for HF in the US from 2010-2019, adjusted all-cause 30-day readmission rates significantly differed by neighborhood household income, and increased over time for patients in the lowest two quartiles of household income. Since adoption of the HRRP, greatest absolute increases in all-cause readmission have been observed among patients in the lowest quartile of neighborhood household income.