Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure

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• 作者：Cherinne Arundel ; MD^a ; Phillip H. Lam ; MD^b ; Rahul Khosla ; MD^a ; Marc R. Blackman ; MD^a ; Gregg C. Fonarow ; MD^c ; Charity Morgan ; PhD^d ; Qing Zeng ; PhD^e ; Ross D. Fletcher ; MD^a ; Javed Butler ; MD ; MPH ; MBA^f ; Wen-Chih Wu ; MD^g ; Prakash Deedwania ; MD^h ; Thomas E. Love ; PhDⁱ ; Michel White ; MD^j ; Wilbert S. Aronow ; MD^k ; Stefan D. Anker ; MD ; PhD^l ; Richard M. Allman ; MD^m ; Ali Ahmed ; MD ; MPH^a ; ^d ; ^{aliahmedmdmph@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：30-Day all-cause readmission ; All-cause mortality ; Cost ; Heart failure ; Medicare beneficiaries
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：129
• 期：11
• 页码：1178-1184
• 全文大小：516 K

文摘

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.