RISK FACTORS FOR RECURRENT HOSPITALIZATION INPATIENTS WITH HEART FAILURE WITH REDUCEDEJECTION FRACTION

Abstract

Background: Heart failure with reduced ejection fraction (HFrEF) is a progressive condition contributing to substantial healthcare burden due to frequent hospital readmissions. Timely identification of associated risk factors is essential for reducing recurrence, improving quality of life, and optimizing hospital resource utilization, especially in low-resource settings. Preventable causes of decompensation continue to challenge post-discharge management strategies in heart failure care.

Objective: To determine the frequency and impact of various risk factors associated with hospital readmissions among patients with HFrEF admitted to Lady Reading Hospital, Peshawar.

Methods: This cross-sectional study was conducted over six months in the Department of Cardiology, Lady Reading Hospital. A total of 122 patients aged 20–80 years with documented HFrEF (EF < 50%) and a history of prior hospitalization for heart failure were enrolled using non-probability consecutive sampling. Data were gathered through structured interviews, clinical examination, and review of medical records. Risk factors assessed included poor drug compliance, NSAID and steroid use, uncontrolled blood pressure, infections, arrhythmias, myocardial infarction, thyroid dysfunction, anemia, hyperglycemia, and electrolyte abnormalities. Statistical analysis was performed using SPSS version 25, with chi-square and Fisher’s exact tests applied. A p-value < 0.05 was considered statistically significant.

Results: Out of 122 patients, 49 (40.2%) experienced unplanned readmission. Among them, 61.2% had poor medication compliance, 53.1% had uncontrolled blood pressure, 40.8% presented with infections, and 36.7% had arrhythmias. Electrolyte disturbances (44.9%), anemia (38.8%), and hyperglycemia (32.7%) were also significantly associated (p < 0.05). Readmitted patients had a mean ejection fraction of 28.7% ± 5.4%, significantly lower than 35.1% ± 7.6% in non-readmitted patients (p < 0.001). Low socioeconomic status was significantly linked with readmissions (p = 0.036).

Conclusion: Recurrent hospitalizations in HFrEF are largely driven by modifiable clinical and behavioral factors. Targeted interventions, including medication adherence reinforcement, blood pressure control, infection management, and socioeconomic support, are critical to improving outcomes and minimizing preventable readmissions.