Clinical Predictors of 30-Day Readmission after Heart Failure Hospitalization in a Low- and Middle-Income Country

Abstract – Introduction: Early hospital readmission after heart failure (HF) hospitalization is a major determinant of morbidity, mortality, and healthcare utilization. Most evidence informing readmission risk prediction originates from high-income countries, with limited data from low- and middle-income countries (LMICs), where healthcare delivery and post-discharge care differ substantially. We aimed to determine the rate and clinical predictors of 30-day readmission following HF hospitalization in an LMIC setting. Methods: We conducted a retrospective cohort study of adult patients hospitalized with a primary diagnosis of HF between January 2020 and December 2022 at a tertiary care center in Pakistan. The primary outcome was unplanned all-cause readmission within 30 days of discharge. Baseline demographic, clinical, and laboratory variables were extracted from electronic health records. Multivariable logistic regression was performed using clinically informed, parsimonious modeling with continuous variables retained. Model discrimination and calibration were assessed using the C-statistic and Hosmer-Lemeshow test, respectively. Results: Among 557 patients hospitalized with HF, 172 (30.9%) experienced 30-day readmission. In multivariable analysis, a prior history of HF hospitalization was independently associated with increased readmission risk (adjusted odds ratio 1.9, 95% confidence interval 1.0–3.8; p = 0.04). Age, sex, HF phenotype, diabetes mellitus, renal function, and natriuretic peptide levels were not independently associated with readmission after adjustment. The model demonstrated acceptable calibration (Hosmer-Lemeshow p = 0.25) and modest discrimination (C-statistic 0.62). Conclusion: Nearly, one-third of patients hospitalized with HF in this LMIC cohort experienced 30-day readmission. Prior HF hospitalization was the only variable independently associated with early readmission, while inpatient clinical markers alone demonstrated limited predictive utility. These findings support the need for transitional care strategies and incorporation of socioeconomic and outpatient care factors into future readmission models in resource-limited settings.