Abstract 4142314: ECG predictors for readmission in patients with heart failure: A meta-analysis

Background: Reducing heart failure (HF) readmission rates remains a global healthcare priority. Current strategies for preventing HF hospitalizations are limited by a lack of accurate predictive models to stratify readmission risk. Electrocardiograms (ECG) provide pertinent information and are broadly available as part of routine cardiac care. We conducted a meta-analysis to identify ECG predictors of readmission in patients with HF. Methods: PubMed, Embase, Cochrane Central and CINAHL were searched, from inception to December 2023. The search strategy was comprised of indexed terms and keywords related to HF, readmission , and electrocardiography. Two reviewers screened relevant studies and extracted data around study design, patient demographics and outcomes. Statistical analysis : Odds Ratio (OR) data and 95% confidence intervals (CI) were calculated on a logarithmic scale using inverse variance method. Pooled OR and 95% CIs were computed using a random-effects model. Results: Of the 409 articles screened, 21 were included for final review. 32,337 patients were analyzed across 8 retrospective studies, 10 prospective cohort studies, 2 registry trials and 1 post-hoc analysis of a randomized control trial. Outcome data were collected for 28 individual ECG variables, which were classified into 5 categories: conduction delay - defined as QRS >120ms (n=7), atrial fibrillation/flutter (n=6), sinus rhythm (n=3), heart rate (n=3), QT C interval (n=3) and QRS-T angle (n=2). Four remaining variables did not fit into these categories (1D). On pooled analysis, presence of atrial fibrillation/flutter [OR 1.54, 95% CI 1.22-1.95, p <0.01] and conduction delay [OR 1.13, 95% CI 1.05-1.22, p <0.01] were associated with higher readmission risk (1A, 1B). Presence of sinus rhythm was associated with lower readmission risk [OR 0.62, 95% CI 0.53-0.72, p <0.01] (1C). Pooled data for heart rate, QRS-T angle and QT C interval were not statistically significant. Conclusion: Presence of atrial fibrillation/flutter and conduction delay on ECG are associated with increased risk while sinus rhythm is associated with lower risk of HF readmission. These findings should be explored further to identify those with HF at risk of readmission.