Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries with Systolic Heart Failure.
Am J Med. 2014 Dec 29;
Authors: Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD, Fonarow GC, Deedwania P, Butler J, Carson P, Love TE, Kheirbek R, Aronow WS, Anker SD, Waagstein F, Fletcher R, Allman RM, Ahmed A
Abstract
BACKGROUND: Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act.
METHODS: Of the 3067 Medicare beneficiaries, discharged alive from 106 Alabama hospitals (1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction <45%, 2202 were not previously on beta-blocker therapy, of which 383 received new discharge prescriptions for beta-blockers. Propensity scores for beta-blocker use, estimated for each of the 2202 patients, were used to assemble a matched cohort of 380 pairs of patients receiving and not receiving beta-blockers who were balanced on 36 baseline characteristics (mean age 73 years, mean EF 27%, 45% women, 33% African American) RESULTS: Beta-blocker use was not associated with 30-day all-cause readmission (hazard ratio {HR}, 0.87; 95% confidence interval {CI}, 0.64-1.18) or heart failure readmission (HR, 0.95; 95% CI, 0.57-1.58)., but was significantly associated with lower 30-day all-cause mortality (HR, 0.29; 95% CI, 0.12-0.73). During 4-year post-discharge, those in the beta-blocker group had lower mortality (HR, 0.81; 95% CI, 0.67-0.98) and combined outcome of all-cause mortality or all-cause readmission (HR, 0.87; 95% CI, 0.74-0.97) but not with all-cause readmission (HR, 0.89; 95% CI, 0.76-1.04).
CONCLUSIONS: Among hospitalized older patients with systolic heart failure, discharge prescription of beta-blockers was associated with lower 30-day all-cause mortality and 4-year combined death or readmission outcomes without higher 30-day readmission.
PMID: 25554369 [PubMed - as supplied by publisher]