Preventability of readmissions for patients with heart failure - A scoping review

Abstract

Background

Heart failure (HF) remains a significant global health issue and poses challenges to patient families and healthcare systems through index hospitalizations and subsequent readmissions. The readmission rate has been utilized as a quality indicator, and a proportion of readmissions are perceived preventable. However, the definitions and measures of preventability remain unclear and inconsistent, lacking an explicit integration, analysis, and critique of current evidence.

Objectives

This scoping review aims to improve the understanding of the definitions and measures of preventable readmissions for patients with HF, by identifying the judgements in published literature and examining the reasonings behind them.

Methods

Systematic literature searches with a search strategy combining three compartments describing preventability, readmission, and HF were conducted. The inclusion and exclusion were performed against prespecified eligibility criteria.

Results

A total of 15 papers were identified. Substantial heterogeneity was observed in study characteristics and judgement of preventability. The proportion of readmissions deemed preventable ranged vastly from 6.66 % to 86 % and required careful interpretation due to inconsistency of denominators. The reasonings behind preventability can be categorized into four groups based on nature, focus, and purpose.

Conclusions

There is currently no consensus on definitions and measures of preventable readmissions for patients with HF. Scattered research efforts were observed with inconsistent and unstandardized methods, criteria, and data used for judgement of preventability. Adopting an identical readmission calculation framework is critical for fair comparison. The timeframe of readmission is worth further reconsideration and investigation. Comprehensive, explicit, and disease-specific judgement criteria for preventable readmissions are urgently needed.