Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure

Multidisciplinary disease management programs for congestive heart failure have been shown to substantially reduce readmission rates, resulting in a reduction of costs. These interventions, however, have typically included changes in medical management, making it difficult to quantitate the key elements of a successful program involving education, discharge planning, and transitional care in the outpatient setting. The investigators utilized an experienced cardiac nurse educator to coordinate a targeted inpatient congestive heart failure education program coupled with comprehensive discharge planning and immediate outpatient reinforcement through a coordinated nurse-driven home health care program. The comprehensive intervention resulted in a marked reduction in 6-month readmission rates, from 44.2% to 11.4% (p=0.01). The average total cost saving for each subject in the interventional group was $1541, based on the decreased utilization of both skilled nursing services and home health care during outpatient follow-up. The costs to implement an inpatient education program were negligible, at $158 per subject. There was no difference in discharge medications or medical management protocols that would have influenced these results.     

Fewer Emergency Readmissions and Better Quality of Life for Older Adults at Risk of Hospital Readmission: A Randomized Controlled Trial to Determine the Effectiveness of a 24-Week Exercise and Telephone Follow-Up Program

OBJECTIVES: To evaluate the effect of an exercise‐based model of hospital and in‐home follow‐up care for older people at risk of hospital readmission on emergency health service utilization and quality of life. DESIGN: Randomized controlled trial. SETTING: Tertiary metropolitan hospital in Australia. PARTICIPANTS: One hundred twenty‐eight patients (64 intervention, 64 control) with an acute medical admission, aged 65 and older and with at least one risk factor for readmission (multiple comorbidities, impaired functionality, aged ≥75, recent multiple admissions, poor social support, history of depression). INTERVENTION: Comprehensive nursing and physiotherapy assessment and individualized program of exercise strategies and nurse‐conducted home visit and telephone follow‐up commencing in the hospital and continuing for 24 weeks after discharge. MEASUREMENTS: Emergency health service utilization (emergency hospital readmissions and visits to emergency department, general practitioner (GP), or allied health professional) and health‐related quality of life (Medical Outcomes Study 12‐item Short Form Survey (SF‐12v2^?) collected at baseline and 4, 12, and 24 weeks after discharge. RESULTS: The intervention group required significantly fewer emergency hospital readmissions (22% of intervention group, 47% of control group, P=.007) and emergency GP visits (25% of intervention group, 67% of control group, P<.001). The intervention group also reported significantly greater improvements in quality of life than the control group as measured using SF‐12v2^? Physical Component Summary scores (F (3, 279)=30.43, P<.001) and Mental Component Summary scores (F (3, 279)=7.20, P<.001). CONCLUSION: Early introduction of an individualized exercise program and long‐term telephone follow‐up may reduce emergency health service utilization and improve quality of life of older adults at risk of hospital readmission.     

The readmission of elderly people to hospital in an inner-city health district

The hospital sector in Britain has, over the last decade, achieved substantial reductions in the average length of stay for patients aged 65 and over. One consequence of this may be increased readmission rates. Furthermore, readmission rates are increasingly being proposed as a surrogate measure of outcome after hospital treatment. All admissions of people aged 65 + to two inner-London hospitals in May 1988 were monitored for 6 months after discharge and readmission rates calculated. Of the 386 patients discharged, 130 (38%) were readmitted within 6 months. The 1 week readmission rate was 6%; at 1 month it was 18%. Readmissions showed no variation regarding age or sex of patients but were related to specialty of treatment and length of stay. Consistently, those readmitted has a shorter length of stay than those not readmitted. If readmission rates are to have any utility as a surrogate outcome indicator they must be calculated on a common basis which relates to unplanned readmissions occurring fairly rapidly after discharge, and are related to the index admission.     

Evaluation of a home-based intervention in heart failure patients. Results of a randomized study

INTRODUCTION AND OBJECTIVES: Home-based interventions after hospital discharge in patients with heart failure (HF) have been shown to decrease readmission and mortality rates. The primary aim of this study was to determine the effect of a home-based educational intervention carried out by nursing staff on the readmission rate, emergency department visits, and healthcare costs. PATIENTS AND METHOD: Patients hospitalized with systolic HF were randomly assigned to receive either usual care or a single home-based educational intervention 1 week after discharge. RESULTS: Between July 2001 and November 2002, 70 patients entered the study: 34 in the intervention group and 36 in the control group. During the 6-month follow-up, there were fewer unplanned readmissions in the intervention group than in the control group (0.09 vs 0.94; P<.001), fewer emergency department visits (0.21 vs 1.33; P<.001), and fewer out-of-hospital deaths (2 vs 11; P<.01). Costs were also significantly lower in the intervention group (difference, ; 1190.9; P<.001). Moreover, patient-perceived health status, as indicated by scores on a quality-of-life questionnaire, increased significantly in the intervention group. CONCLUSIONS: In a cohort of patients with systolic HF who received a home-based educational intervention there were significant reductions in the unplanned readmission rate, mortality, and healthcare costs, and better quality of life. Some limitations of the study warrant validation of the resultats in further studies.     

The Paradox of Readmission Prevention Interventions: Missing Those Most in Need

BackgroundPost-hospitalization transition interventions remain a priority in preventing rehospitalization. However, not all patients referred for readmission prevention interventions receive them. We sought to 1) define patient characteristics associated with non-receipt of readmission prevention interventions (among those eligible for them), and 2) determine whether these same patient characteristics are associated with hospital readmission at the state level.MethodsWe used state-wide data from the Maryland Health Services Cost Review Commission to determine patient-level factors associated with state-wide readmissions. Concurrently, we conducted a retrospective analysis of discharged patients referred to receive 1 of 3 post-discharge interventions between January 2013 and July 2019—a nurse transition guide, post-discharge phone call, or follow-up appointment in our post-discharge clinic—to determine patient-level factors associated with not receiving the intervention. Multivariable generalized estimating equation logistic regression models were used to calculate the odds of not accepting or not receiving the interventions.ResultsOlder age, male gender, black race, higher expected readmission rate, and lower socioeconomic status were significantly associated with 30-day readmission in hospitalized Maryland patients. Most of these variables (age, sex, race, payer type [Medicaid or non-Medicaid], and socioeconomic status) were also associated with non-receipt of intervention.ConclusionsWe found that many of the same patient-level characteristics associated with the highest readmission risk are also associated with non-receipt of readmission reduction interventions. This highlights the paradox that patients at high risk of readmission are least likely to accept or receive interventions for preventing readmission. Identifying strategies to engage hard-to-reach high-risk patients continues to be an unmet challenge in readmission prevention.     

The impact of Hospital Elder Life Program interventions,on 30-day readmission Rates of older hospitalized patients

ObjectiveThis study investigated the impact of the Hospital Elder Life Program (HELP), a geriatric intervention program targeted at reducing delirium, on readmission rates. Secondary goals were to review HELP’s impact on average length of stay (ALOS), discharge to the home, and falls.DesignThis retrospective 3-year study reviewed inpatients age 70 and older, with one or more of six impairments: functional, renal, cognitive, sleep, visual and hearing. Patients were from a 784 bed teaching hospital in California with admissions between January 1, 2014 and December 31, 2016. This was compared to a matched cohort of patients who did not receive any interventions from HELP volunteers or a HELP geriatric nurse practitioner. Data was also reviewed for impact on goals in age groups 70–85 and 85 + .Results2146 HELP patients with an average age of 82.1 showed improvement in 30-day readmission rates, with a readmission rate of 11.3% in the HELP group and 13.5% in the control group (n = 2704, mean 82.5). Detailed age data noted statistical significance only in the 70–85 population for readmission. ALOS was 5.6 and 6.2 days respectively in the HELP and non-HELP population. ALOS was also statistically significant across 70–85 and 85 + . Neither rates of discharge to home nor falls showed any significant improvement. Both control and intervention groups had a disproportionate number of whites and females.ConclusionThis study shows hospitals can improve patient outcomes and financial burden from 30-day readmissions and length of stay, particularly in the 70–85 age group, by implementing the Hospital Elder Life Program.     

A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization]

BACKGROUND: Hospital admissions for heart failure are common and readmission rates are high. Many admissions and readmissions may be avoidable, so that alternative strategies are needed to improve long-term management. METHODS: We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet and intensive application of guidelines' recommendations on pharmacological therapy. The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months. Two hundred and nine guideline-managed patients were compared to 209 concurrent normally-discharged patients. RESULTS: Patients in the study group were more prescribed beta-blockers, ACE-inhibitors, angiotensin receptor blockers, and spironolactone. Sixteen patients (8%) in the intervention group and 31 (15%) among controls were readmitted for DRG 127, within 3 months of discharge (Fisher's exact test, p < 0.01), while the 6-month mortality rate was similar between groups (9 and 11.5% respectively). Quality of life significantly improved from 5.6 +/- 1.0 to 6.1 +/- 1.9 (Mann-Whitney U-test, p < 0.05). The overall costs of care were lower for guideline-managed patients (110 vs 150 Euro per patient per month), due to the lower readmission rates. CONCLUSIONS: Our study showed that a guideline-based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days, allowing relevant cost savings.     

A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure

BACKGROUND: Heart failure is the leading cause of hospitalization and readmission in many hospitals worldwide. We performed a meta-analysis to evaluate the effectiveness of multidisciplinary heart failure management programs on hospital admission rates. METHODS: We identified studies through an electronic search and mortality using 8 distinct methods. Eligible studies met the following criteria: (1) randomized controlled clinical trials of adult inpatients hospitalized for heart failure enrolled either at the time of discharge or within 1 week after discharge; (2) heart failure-specific patient education intervention coupled with a postdischarge follow-up assessment; and (3) unplanned readmission reported. Four reviewers independently assessed each study for eligibility and quality, achieving a weighted kappa of 0.73 for eligibility and 0.77 for quality. For each study we calculated the relative risk for readmissions and mortality for patients receiving enhanced education relative to patients receiving usual care. RESULTS: A total of 529 citation titles were identified, of which 8 randomized trials proved eligible. The pooled relative risk for hospital readmission rates using a random-effects model was 0.79 (95% confidence interval, 0.68-0.91; P<.001; heterogeneity P = .25). There was no apparent effect on mortality (relative risk, 0.98; 95% confidence interval, 0.72-1.34; P = .90; heterogeneity P = .20). Data were insufficient to meaningfully pool intervention effects on quality of life or compliance. CONCLUSION: This systematic review suggests that specific heart failure-targeted interventions significantly decrease hospital readmissions but do not affect mortality rates.     

Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program

AIMS: Disease management programs can reduce hospitalizations in high-risk heart failure (HF) patients, but generalizability to the population hospitalized for HF remains to be proven. We aimed to assess the effectiveness of a discharge and outpatient management program in a non-selected cohort of patients hospitalized for HF. METHODS AND RESULTS: Patients admitted with decompensated HF were randomized to receive usual care (n=174) or an intervention (n=164) consisting of a comprehensive hospital discharge planning and close follow-up at a HF clinic. After a median of 509 days, there were fewer events (readmission or death) in the intervention as compared with the control group (156 vs. 250), which represents 47% (95%CI: 29-65; P<0.001) event reduction per observation year. At 1-year, time to first event, time to first all-cause and HF readmission, and time to death were increased in the intervention group (P<0.001). All-cause and HF readmission rates per observation year were significantly lower, quality of life improved and overall cost of care was reduced in the intervention group. CONCLUSIONS: This comprehensive hospital discharge and outpatient management program prolonged time to first event, reduced hospital readmissions, improved survival and quality of life of patients hospitalized for HF, while reducing cost of management.     

Trends,etiologies, and predictors of 90‐day readmission after percutaneous ventricular assist device implantation: A national population‐based cohort study

Percutaneous ventricular assist devices (pVADs) are indicated to provide hemodynamic support in high‐risk percutaneous interventions and cardiogenic shock. However, there is a paucity of published data regarding the etiologies and predictors of 90‐day readmissions following pVAD use. We studied the data from the US Nationwide Readmissions Database (NRD) for the years 2013 and 2014. Patients with a primary discharge diagnosis of pVAD use were collected by searching the database for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedural code 37.68 (Impella and TandemHeart devices). Amongst this group, we examined 90‐day readmission rates. Comorbidities as identified by “CM_” variables provided by the NRD were also extracted. The Charlson Comorbidity Index was calculated using appropriate ICD‐9‐CM codes, as a secondary diagnosis. A 2‐level hierarchical logistic regression model was then used to identify predictors of 90‐day readmission following pVAD use. Records from 7074 patients requiring pVAD support during hospitalization showed that 1562 (22%) patients were readmitted within 90 days. Acute decompensated heart failure (22.6%) and acute coronary syndromes (11.2%) were the most common etiologies and heart failure (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.17–1.67), chronic obstructive pulmonary disease (OR: 1.26, 95% CI: 1.07–1.49), peripheral vascular disease (OR: 1.305, 95% CI: 1.09–1.56), and discharge into short‐ or long‐term facility (OR: 1.28, 95% CI: 1.08–1.51) were independently associated with an increased risk of 90‐day readmission following pVAD use. This study identifies important etiologies and predictors of short‐term readmission in this high‐risk patient group that can be used for risk stratification, optimizing discharge, and healthcare transition decisions.     

Effect of discharge summary availability during post-discharge visits on hospital readmission

OBJECTIVE: To determine if the delivery of hospital discharge summaries to follow-up physicians decreases the risk of hospital readmission. SUBJECTS: Eight hundred eighty-eight patients discharged from a single hospital following treatment for an acute medical illness. SETTING: Teaching hospital in a universal health-care system. DESIGN: We determined the date that each patient's discharge summary was printed and the physicians to whom it was sent. Summary receipt was confirmed by survey and phoning each physician's office. Each patient's hospital chart was reviewed to determine their acute and chronic medical conditions as well as their course in hospital. Using population-based administrative databases, all post-hospitalization visits were identified. For each of these visits, we determined whether the summary was available. MAIN OUTCOME MEASURES: Time to nonelective hospital readmission during 3 months following discharge. RESULTS: The discharge summary was available for only 568 of 4,639 outpatient visits (12.2%). Overall, 240 (27.0%) of patients were urgently readmitted to hospital. After adjusting for significant patient and hospitalization factors, we found a trend toward a decreased risk of readmission for patients who were seen in follow-up by a physician who had received a summary (relative risk 0.74, 95% confidence interval 0.50 to 1.11). CONCLUSIONS: The risk of rehospitalization may decrease when patients are assessed following discharge by physicians who have received the discharge summary. Further research is required to determine if better continuity of patient information improves patient outcomes.     

Analysis of trends in hospitalizations for heart failure.

BACKGROUND: Over the past 10 years, efforts have been made to control the cost of care for patients with congestive heart failure (CHF) through reducing hospitalizations and shortening lengths of stay. Few data are available regarding the effectiveness of these intervention strategies on a community basis. METHODS AND RESULTS: We analyzed the Oregon hospital discharge database. Multivariable methods were used to assess trends while controlling for confounding factors, such as age, sex, and comorbidity. The hospital admission rates for CHF were stable over time in all age groups. The age- and sex-standardized admission rate among people aged 65 years or older decreased slightly from 13.9/1,000 in 1991 to 12.9/1,000 in 1995. The annual hospital readmission rate remained constant over time, with an average rate of 15.3%. The average length of hospital stay decreased from 5.01 days in 1991 to 3.95 days in 1995. The in-hospital mortality rate decreased from 6.9% in 1991 to 4.7% in 1995, independent of length of stay. CONCLUSION: We observed stable hospital admission and readmission rates for CHF, accompanied by a decreasing trend in the length of hospital stay and in-hospital mortality. Our findings raise the possibility of improved care management for heart failure over time.     

Burden of 30-Day Readmissions Associated With Discharge Against Medical Advice Among Inpatients in the United States

BackgroundDischarges against medical advice are common among inpatients in the United States. The impact of discharge against medical advice on readmission rates and subsequent hospitalization outcomes is uncertain. We sought to ascertain the effect of discharge against medical advice on 30-day readmission rates and outcomes of readmission.MethodsWe used the 2014 Nationwide Readmissions Database to identify index hospitalizations among patients older than 18 years of age. The primary exposure variable was discharge against medical advice, and the primary outcome measure was all-cause unplanned 30-day readmission. We used multivariate hierarchical logistic regression modeling to ascertain the effect of discharge against medical advice on 30-day readmission rates.ResultsThere were an estimated 23,110,641 index hospitalizations nationwide with an overall unplanned 30-day readmission rate of 10.2%. 1.3% of index admissions resulted in a discharge against medical advice. Patients who were discharged against medical advice were younger (mean age 47.1 years vs 56.5 years, P < 0.001) with a higher proportion of males (61.1% vs 39.5%, P < 0.001) compared with patients with a routine discharge. Discharge against medical advice was associated with significantly higher odds of 30-day readmission (risk-adjusted odds ratio [OR] 2.06, 95% confidence interval [CI] 2.03-2.09, P < 0.001). Discharge against medical advice was associated with higher odds of readmission to a different hospital (OR 2.35, 95% CI 2.22-2.49, P < 0.001) and repeat discharge against medical advice after readmission (OR 18.41, 95% CI 17.46-19.41, P < 0.001). The most common cause of readmission after discharge against medical advice was alcohol-related disorders (9%). Hospital-level rates of discharge against medical advice ranged from 0% to 12.5%.ConclusionsDischarge against medical advice is associated with over twice the odds of all-cause unplanned 30-day readmission compared with routine discharge. There is large hospital-level variation in rates of discharge against medical advice. Interventions to reduce discharges against medical advice, particularly at hospitals with high rates of such discharges, may reduce the overall readmission burden in this challenging and high-risk patient population.     

Nurse tele-consultations with discharged COPD patients reduce early readmissions--an interventional study

Introduction: Exacerbations of chronic obstructive pulmonary disease (ECOPD) are the most common cause for admissions and readmissions to medical wards worldwide. Objectives: To investigate the effect on early readmissions of telemedicine video consultations (TVCs) between respiratory nurses placed at the hospital and COPD patients in their homes after a discharge from the hospital, which was caused by ECOPD. Methods: This study was an interventional study in which all ECOPD were consecutively allocated into two groups (TVC or control) depending on their home municipality. The patient received daily TVC at home with a nurse based at the hospital for approximately one week. Thereafter, the patient received at least one follow‐up call and they could call the nurse for the rest of the study period of 28 days. The telemedicine equipment was composed of a computer with a web camera, a microphone and measurement equipment. Results: Within each of the two groups, TVC (n = 50) and control (n = 50), 12% and 22%, respectively, were readmitted [differences between rates –10% (95% confidence interval –25;5)] because of ECOPD. The multivariate Cox regression model showed the TVC assignment as a significant protective factor for early readmission [hazard ratio (HR) 0.25 (0.09–0.69)]. High age [HR 3.94 (1.46–10.6)] and male gender [HR 2.97 (0.99–8.97)] were associated with high hazard. Patient satisfaction was high. Conclusions: In a hospitalised population with ECOPD, a nurse TVC assignment is protective against early readmission and reduces the days of readmission. Please cite this paper as: Sorknæs AD, Madsen H, Hallas J, Jest P and Hansen‐Nord M. Nurse tele‐consultations with discharged COPD patients reduce early readmissions – an interventional study. Clin Respir J 2011; 5: 26–34.     

Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients – a randomised controlled trial

Purpose Previous studies reported reduced risk of readmission, mortality and shorter length of hospital stay (LOS) among geriatric patients receiving an early (<24h), hospital-based geriatric team intervention after discharge. The objective of this study was to compare a novel, early municipality-based, nurse-led and general practitioner (GP)-supported transitional care intervention (TCI) to an established hospital-based TCI among frail, older, geriatric patients.Material and methods A randomised controlled trial was conducted within a single geriatric department and the adjacent municipality. Inclusion criteria: acutely admitted, frail patients 75+ years old. Eligible patients were randomly allocated (1:1) to the two TCIs. Primary outcome was 30-day unplanned readmission. Secondary outcomes were 90-day all-cause mortality and LOS. Stratified analysis according to type of dwelling was made. Odds ratios (OR) with 95% confidence intervals (CI), and number needed to treat (NNT) were reported.Results 3,103 patients (median age (IQR): 85 (80-90); 57% female) were included. Readmission rates were 22% in the municipality-based intervention (n=332/1,545), and 18% in the hospital-based intervention (n=276/1,558); OR was 1.27, 95% CI (1.06-1.52), p=0.008 and NNT=27. OR for cohabiting patients was 1.47, 95% CI (1.02-2.08); p=0.035. No significant difference was observed in mortality (22% vs. 21%; OR=1.05, 95% CI (0.89-1.25), p=0.577) or LOS (median (IQR): 6 (2-8) vs. 6 (2-8) days, p=0.1787).Conclusions The new municipality-based, nurse-led and GP-supported intervention was inferior to the hospital-based geriatric team intervention in preventing 30-day readmission among frail, geriatric patients. There was no significant difference between the two interventions in regard to 90-day mortality or LOS.     

Patient stratification for risk of readmission due to heart failure by using nationwide administrative data

BackgroundIdentifying patients with heart failure (HF) who are most at risk of readmission permits targeting adapted interventions. The use of administrative data enables regulators to support the implementation of such interventions.Methods and ResultsIn a French nationwide cohort of patients aged 65 years or older, surviving an index hospitalization for HF in 2015 (N = 70,657), we studied HF readmission predictors available in administrative data, distinguishing HF severity from overall morbidity and taking into account the competing mortality risk, over a 1-year follow-up period. We also computed cumulative incidences and daily rates of HF readmission for patient groups defined according to HF severity and overall morbidity. Of the patients, 31.8% (n = 22,475) were readmitted at least once for HF, and 17.6% (n = 12,416) died without any readmission for HF. HF severity and overall morbidity were the strongest readmission predictors were the strongest readmission predictors (subdistribution hazard ratios 2.66 [95% CI: 2.52–2.81] and 1.37 [1.30–1.45], respectively, when comparing extreme categories). Overall morbidity and age were more strongly associated with the rate of death without HF readmission (cause-specific hazard ratios). The difference in observed HF readmission between patient risk groups was approximately 40% (21.9%, n = 2144/9,786 vs 60.4%, n = 618/1023).ConclusionsSegmentation of HF patients into readmission risk groups is possible by using administrative data, and it enables the targeting of preventive interventions.     

Effects of a postdischarge clinic on housestaff satisfaction and utilization of hospital services

This randomized, controlled clinical trial evaluated the effect of a postdischarge clinic on housestaff education and patient utilization of hospital services. Medicine housestaff were randomized either to attend a clinic once a week in which they saw all eligible patients they had recently discharged from the hospital, or to continue with usual discharge practices. We enrolled 751 patients, 312 on intervention teams and 439 on control teams. Intervention housestaff did not feel that the clinic took too much time and felt that they better knew how patients did after discharge. Fewer intervention patients had emergency room visits (28.0% to 20.8%,p=.03) in the 30 days after discharge. Length of stay, readmission rates, and mortality were similar for the two groups. We conclude that a postdischarge clinic can improve resident education and reduce postdischarge emergency room utilization.     

MitraClip 30-Day Readmissions and Impact of Early Discharge: An Analysis from the Nationwide Readmissions Database 2016

Background/PurposeEdge-to-edge mitral valve repair (MVR) using the MitraClip (Abbott Vascular, Santa Clara, CA), is now labeled for patients with degenerative and functional mitral regurgitation. Because this is a minimally invasive transcatheter procedure, patients are commonly discharged early post-procedure, yet rates and causes of early readmissions are unknown. This study aimed to evaluate underlying causes and trends of 30-day readmissions using the 2016 US Nationwide Readmissions Database (NRD) in patients discharged early after MVR with MitraClip.Methods/materialsWe identified all patients who received a MitraClip in 2016 and then identified a cohort of patients who were discharged early (<48 h). Next, any admission within 30 days of the index procedure was identified.ResultsOur analysis included 3858 MitraClip patients. The overall 30-day readmission rate was 13.5%. A total of 2341 patients (61%) were discharged early. The readmission rate among the early discharge cohort was 10.1% (233/2314). The readmission rate among the early discharge cohort was 10.1% (233/2314). The major causes of readmission were heart failure (27.5%), infections (15.5%), and postprocedural complications (6.9%).ConclusionsEarly discharge post-MitraClip treatment is feasible, safe, and associated with low readmission rates as compared to all MitraClip procedures performed. Special considerations for early discharge should apply to postprocedural complications and patients with heart failure, the most common readmission causes, as these may require longer stays post-procedure.SummaryThis study aimed to evaluate underlying causes and trends of 30-day readmissions using the US Nationwide Readmissions Database (NRD) 2016 dataset in patients discharged early after mitral valve repair with MitraClip. The overall 30-day readmission rate during this period was 13.5%; the readmission rate among patients discharged early (<48 h) was 10.1%. Early discharge post-MitraClip treatment is feasible and safe and is associated with low readmission rates.