Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.
Citation: American Journal of Medicine. 129(11):1178-1184, 2016 NovPMID: 27401949Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure/th [Therapy] | *Mortality | *Patient Readmission/sn [Statistics & Numerical Data] | Aged | Aged, 80 and over | Alabama/ep [Epidemiology] | Case-Control Studies | Cohort Studies | Comorbidity | Coronary Artery Disease/ep [Epidemiology] | Diabetes Mellitus/ep [Epidemiology] | Female | Follow-Up Studies | Heart Failure/ep [Epidemiology] | Hospitalization | Humans | Male | Medicare | Middle Aged | Multivariate Analysis | Prognosis | Propensity Score | Proportional Hazards Models | Pulmonary Disease, Chronic Obstructive/ep [Epidemiology] | Renal Insufficiency, Chronic/ep [Epidemiology] | Treatment Outcome | United StatesYear: 2016Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - presentISSN:- 0002-9343
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
---|---|---|---|---|---|---|
Journal Article | MedStar Authors Catalog | Article | 27401949 | Available | 27401949 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
BACKGROUND: Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure.
CONCLUSIONS: Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost.
Copyright Published by Elsevier Inc.
METHODS: Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without a 30-day all-cause readmission, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American).
RESULTS: During 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, 8,972 vs 4,025; P = .001) during 8.7 years of follow-up.
English