Qualitative Content Analysis of Unplanned Readmissions in Patients With Acute Heart Failure.

Background: Unplanned readmissions in patients with acute heart failure generate a substantial burden on healthcare systems and are associated with significant morbidity and mortality. Heart failure admissions are projected to increase over time with the ageing population. Understanding the factors contributing to readmissions after an index admission for heart failure is important, in order to develop strategies to address this phenomenon.

Aim: To understand the patient and organisational factors that contribute to readmissions in patients who are admitted with acute heart failure.

Method: Qualitative content analysis was performed on clinical notes from electronic medical records of all patients readmitted within 30 days after admission with acute heart failure at a single tertiary referral centre, between June 2022 and January 2023. Text related to patient and system-related factors contributing to readmissions were coded and organised into categories and sub-categories. The frequency of codes per patient was generated as a surrogate marker of the relative importance of codes within the dataset.

Results: Overall, 64 patients were readmitted within the study timeframe. Three main categories emerged from the analysis, including patient-related medical factors contributing to readmission, patient-related psychosocial factors, and system-related factors. Patient-related medical factors were the most dominant category, with sub-categories of "non-heart failure causes of readmission", "frailty or functional decline", or "severe underlying cardiac pathology" occurring most frequently within the cohort (60.9%, 48.4%, 42.2%, respectively).

Conclusions: This study explores the patient-related medical, psychosocial, and system-related factors as significant contributors to readmissions in acute heart failure patients. It underscores the need for comprehensive and multi-faceted interventions to improve patient outcomes in this population and reduce healthcare burdens.