Zarich, Stuart

Introduction: Testing for coronary artery disease (CAD) is recommended for patients with new-onset heart failure (HF). There are limited data on the association between testing for CAD during index hospitalization for patients with the new-onset HF and early readmission rates and readmission mortality. Hypothesis: CAD testing for new-onset HF during index hospitalization may reduce 30-day readmission rates and readmission-related mortality. Methods: Patients hospitalized for new-onset HF were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, 30-day readmission rates, readmission-related mortality were compared in patients with or without testing for CAD during index hospitalization. CAD testing includes coronary angiography, coronary CT angiography, cardiac MRI, nuclear imaging or cardiac stress test. Results: Between January 2016 and November 2019, of 151,172 patients hospitalized for new-onset HF, 30,444 (20.1%) patients underwent testing for CAD during index hospitalization. Younger patients, males, and patients with HF with reduced ejection fraction (HFrEF) had more frequent testing for CAD. Only 9.5% of CAD-tested patients received percutaneous coronary intervention during the index hospitalization. Patients with CAD testing had lower 30-day readmission rates than those without testing (11.4% vs 14.3%, P<0.001; adjusted odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76 to 0.87). Patients with CAD testing had lower 30-day readmission-related mortality rates than those without testing (0.5% vs 0.9%, P<0.001; adjusted OR 0.82, 95% CI 0.65 to 1.04). Readmission rate for HF at 30 days was 2.3% for patients with CAD testing vs 3.5% for those without testing (P<0.001; adjusted OR 0.67, 95% CI 0.59 to 0.76). There was a significant interaction between HF type (HFrEF vs HF with preserved EF) and CAD testing on 30-day readmission rates (P for interaction <0.001). Conclusions: Testing for CAD during index hospitalization for patients with new-onset HF was associated with reduced 30-day readmission rates. There was substantial decrease in readmission for HF and readmission-related mortality in patients who underwent CAD testing during index hospitalization.