Risk of 30-Day Readmission in Adults with Heart Failure or AMI by HIV Status
Overview
People with HIV (PWH) hospitalized for heart failure (HF) or acute myocardial infarction (AMI) have a significantly higher risk of 30-day all-cause unplanned readmission compared to people without HIV (PWoH). From 2016 to 2022, readmission risks declined overall but remained disproportionately elevated among PWH, especially in younger males and older females.
Background
Hospital readmission within 30 days is a key quality-of-care metric linked to increased healthcare costs and is targeted by the Hospital Readmissions Reduction Program. Cardiovascular disease, including HF and AMI, is a leading cause of hospitalization and mortality in the US, with substantial economic burden. People with HIV are living longer due to antiretroviral therapy but face higher incidence of cardiovascular conditions and readmission risks compared to those without HIV. National data on readmission risk by HIV status have been limited, prompting this large-scale analysis using the Nationwide Readmissions Database.
Data Highlights
Year
30-Day Readmission Risk in PWH with HF (%)
30-Day Readmission Risk in PWoH with HF (%)
30-Day Readmission Risk in PWH with AMI (%)
2016
39.5
22.9
19.3
2022
33.0
21.6
16.8
Key Findings
From 2016 to 2022, 30-day readmission risk declined for PWH hospitalized with HF from 39.5% to 33.0%, and for PWoH with HF from 22.9% to 21.6%.
For AMI hospitalizations, PWH readmission risk decreased from 19.3% to 16.8% over the same period.
In 2022, PWH had a 46% higher adjusted risk of 30-day readmission after HF hospitalization (aRR=1.46) and a 59% higher risk after AMI hospitalization (aRR=1.59) compared to PWoH.
The most common readmission diagnoses after HF were hypertensive heart disease and chronic kidney disease with HF; after AMI, recurrent unspecified AMI was most common for both groups.
Age- and sex-stratified analyses showed the greatest disparities in readmission risk among younger males and older females living with HIV.
Clinical Implications
Clinicians should recognize that adults with HIV hospitalized for HF or AMI are at substantially increased risk for early readmission. Targeted strategies such as early post-discharge follow-up and multidisciplinary care coordination may help reduce preventable readmissions in this vulnerable population. Awareness of common readmission diagnoses can guide tailored interventions to address comorbid conditions.
Conclusion
Despite overall declines in 30-day readmissions, people with HIV continue to experience significantly higher readmission risks after HF and AMI hospitalizations compared to those without HIV. Focused efforts are needed to mitigate these disparities and improve cardiovascular outcomes in PWH.
References
Nationwide Readmissions Database (NRD) / HCUP / 2016-2022 -- Data Source and Methodology
Centers for Medicare and Medicaid Services (CMS) / Hospital Readmissions Reduction Program / 2012
American Heart Association / Cardiovascular Disease Costs Projection / 2022
