Serum Vitamin D Levels Predict 30-day Readmission Rate and Length of Stay in Hospitalized Patients with an Acute Heart Failure Syndrome due to Reduced Ejection Fraction

Journal of Cardiac Failure Vol. 23 No. 8S August 2017
Fadi Ghrair1, Hassan Alkhawam2, Anwar Zaitoun3, Feras Zaiem4, Amir Sara5, David Rubinstein6, Timothy J. Vittorio7; 1Icahn School of Medicine at Mount Sinai (Elmhurst), Astoria, NY; 2Saint Louis University School of Medicine, St. Louis, MO; 3Saint John Hospital and Medical Center, Detroit, MI; 4Mayo Clinic, Rochester, MN; 5Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 6Icahn School of Medicine at Mount Sinai (Elmhurst), New York, NY; 7St. Francis Hospital—the Heart Center®, Roslyn, NY

Introduction: More than 90% of patients with heart failure with reduced ejection fraction (HErEF) are vitamin D deficient. Lower vitamin D levels have been linked to higher NYHA classes and increased mortality among HFrEF patients. However, data on the relationship between serum vitamin D level and hospitalization are scarce. Our study aims to assess the association of serum vitamin D level with 30-day readmission rate and length of stay (LOS) in patients with acute heart failure (AHF) syndrome due to HFrEF.

Methods: Aretrospective, single-center study of 2,087 patients admitted between January 1, 2005 and December 31, 2014 for an AHF syndrome was performed. Patients without a vitamin D level or measured as 25-dihydroxyvitamin D (25OHD were excluded from our study. 25(OH)D deficiency was defined by having serum concentration levels of less than 20 ng/mL. Normal levels were defined as >30 ng/mL. We assessed levels of 25(OH)D in relation to predicting the 30-day readmission rate, length of stay (LOS) and mortality rate.

Results: Among the 2,087 patients admitted to our hospital for an AHF syndrome, 180 patients had a history of HFrEF and documented levels of vitamin D, of which 42 patients (23.3%) had normal 25(OH)D levels, 83 patients (46.1%) had 25(OH)D deficiency and 55 patients (30.6%) had 25(OH)D insufficiency. The average age of the patients admitted for an AHF syndrome was 62.7 years in HFrEF-25(OH)D deficiency group versus 69.9 years in HFrEF-normal 25(OH)D level (P = .007).

After standardizing medical therapy in each group, the 30-day readmission rate among HFrEF-25(OH)D deficiency was 40% versus 16.6% in HFrEF- normal 25(OH)D level (Odds ratio (OR) 3.4, 95% CI: 1.3-9.3, P = .01). Average LOS among HFrEF-25(OH)D deficiency group was 8.2 days versus 4.1 days in HFrEF- normal 25(OH)D level (P = .04).

Mortality rate did not differ between the two groups. Subgroup analysis among HFrEF-25(OH)D deficiency, average age during the AHF syndrome admission was 60.1 years among male patients versus 67 years in female patients (P = .04). Furthermore, female patients had a higher 30-day readmission rate compared to male patients (26.7% vs 11.8%) with a trend toward statistical significance (P = .07). LOS did not differ between the male and female subgroups (P = .8).

Conclusions: Vitamin D deficiency seems to be a significant independent predictor for an early age of hospitalization, 30-day readmission rate and LOS among HFrEF patients admitted for anAHF syndrome. Further studies are warranted to evaluate vitamin D supplementation on patient outcomes.