Does symptom burden influence readmission risk in heart failure? A secondary analysis of randomized controlled trial

People living with heart failure (HF) often experience significant physical and psychological symptom burden, which impair quality of life and contribute to adverse outcomes, including hospital readmissions.

To (a) identify latent profiles of symptom burden in patients with HF and (b) examine their associations with hospital readmission.

This is a secondary analysis from the MIGHTy-Heart study, a pragmatic comparative effectiveness trial evaluating mobile integrated health interventions among patients with HF. Latent Profile Analysis (LPA) was conducted using items from the PROMIS-29 (fatigue, anxiety, pain interference, physical function, and ability to participate in social activities) to identify subgroups of symptom burden. A three-class symptom burden solution was selected (AIC = 101,543, BIC = 101,711, entropy = 0.782, minimum class probability = 0.883), labeled as Low (n=339), Moderate (n=851), and High (n=762) symptom burden. Cox proportional hazards models were used to examine time to hospital readmission at 30, 60, and 90 days, with symptom burden class as key predictor. Models were adjusted for sex, age, treatment arm, and Charlson comorbidity index.

Among 1,911 patients (median age=67 years, 47% Black, 52% female), comorbidities included hypertension, diabetes, and chronic kidney disease. In adjusted models, at 60 days, patients in the Moderate symptom burden class had a 31% higher hazard of readmission compared to those in the Low burden class (aHR=1.311, 95% CI=1.023 – 1.679). At 90 days, the hazard remained elevated (aHR=1.270, 95% CI=1.021–1.580). The High symptom burden class did not show increased hazards of readmission at any time point neither in adjusted nor unadjusted models.

Symptom burden may be a useful clinical marker for readmission risk, particularly when symptoms are modestly elevated but not yet severe. Nurses should closely monitor patients with moderate symptom burden who may otherwise go unnoticed. While high symptom burden may be of concern for clinicians, further research should explore why it does not necessarily translate into higher risk of readmission.