Association Between Constipation and All-Cause Readmission in Elderly Patients With Heart Failure

Background: Readmission is a common and serious economical and clinical issue associated with heart failure (HF). Constipation could affect dysbiosis associated with adverse outcome including readmission. Purpose: The purpose of this study was to investigate the association between constipation and readmission independent of and incremental to HF clinical risk scores. Methods: To determine all-cause readmission, 452 admitted patients with HF were followed up (median age: 81 years; median follow-up duration: 1.1 years). Constipation was defined as regular use of a purgative or <3 stools per week during the index admission. The three conventional clinical risk scores for predicting readmission [Score 1 (Yale CORE score): Keenan 2008, Score 2: Krumholz 2000, and Score 3: Philbin 1999] were also measured. Cox proportional hazard analysis was used to assess independence and net reclassification improvement for incremental benefit. Results: Constipation was frequently observed (n = 182, 40%). Constipation was associated with all-cause readmission (n = 269, 60%) independent of all risk scores (P < .05 for all). However, including constipation did not show significant reclassification improvement in the risk scores for predicting readmission. Conclusions: Constipation is common and appears to be an important risk factor for readmission in elderly patients with HF. However, the addition of constipation did not improve the predictive value of conventional clinical risk scores for readmission.