1. Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.
- Author
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Arundel, Cherinne, Lam, Phillip H, Khosla, Rahul, Blackman, Marc R, Fonarow, Gregg C, Morgan, Charity, Zeng, Qing, Fletcher, Ross D, Butler, Javed, Wu, Wen-Chih, Deedwania, Prakash, Love, Thomas E, White, Michel, Aronow, Wilbert S, Anker, Stefan D, Allman, Richard M, and Ahmed, Ali
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HEART failure treatment , *CHRONIC kidney failure , *CORONARY disease , *DIABETES , *HEART failure , *HOSPITAL care , *LONGITUDINAL method , *OBSTRUCTIVE lung diseases , *MEDICARE , *MORTALITY , *MULTIVARIATE analysis , *PROBABILITY theory , *PROGNOSIS , *RESEARCH funding , *COMORBIDITY , *TREATMENT effectiveness , *PROPORTIONAL hazards models , *CASE-control method , *PATIENT readmissions - Abstract
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.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, $38,972 vs $34,025; P = .001) during 8.7 years of follow-up.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. [ABSTRACT FROM AUTHOR]- Published
- 2016
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