Heart failure, the fifth most common cause for hospitalization, is associated with the highest 30-day readmission rate among all diagnoses in the United States. A strong incentive to reduce 30-day readmissions has come from the association between increased mortality and subsequent heart failure readmissions, as well as reimbursement penalties imposed on hospitals in cases of 30-day all-cause readmissions for heart failure patients. This quality improvement project designed to elucidate the utility of this recommendation for local implementation did not find evidence to support the use of a 24-hour cutoff point for inpatient observation of patients with chronic stage C heart failure with reduced left ventricular ejection fraction hospitalized for acute-on-chronic decompensated heart failure. This result should be interpreted with caution given the project's methodological limitations inherent to the observational design and small sample size.
