Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.
Am J Med. 2016 Jul 8;
Authors: Arundel C, Lam P, Khosla R, Blackman MR, Fonarow GC, Morgan C, Zeng Q, Fletcher RD, Butler J, Wu WC, Deedwania P, Love TE, White M, Aronow WS, Anker SD, Allman RM, Ahmed A
Abstract
BACKGROUND: Heart failure is the leading cause for 30-day all-cause readmission. However, its associations with long-term outcomes and cost have not been studied in propensity score-matched cohorts.
METHODS: Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30-day post-discharge, 1519 had 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 11 months of post-readmission follow-up, all-cause mortality occurred in 41% and 27% of matched patients with and without 30-day all-cause readmission, respectively (hazard ratio {HR}, 1.68; 95% confidence interval {CI}, 1.48-1.90; p<0.001). This harmful association of 30-day all-cause readmission with mortality persisted throughout 8.7 (mean, 3.1) years of follow-up (HR, 1.33; 95% CI, 1.22-1.45; p<0.001). Patients in the 30-day all-cause readmission group had higher cumulative all-cause readmissions (mean, 6.9 vs. 5.1; p<0.001), longer cumulative length of stay (mean, 51 vs. 43 days; p<0.001) and higher cumulative cost (mean, $38,972 vs. $34,025; p=0.001) during 8.7 years of follow-up. Similar associations were observed between 30-day all-cause readmission and heart failure readmissions.
CONCLUSIONS: Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, which was also associated with higher number of cumulative all-cause and heart failure readmissions, longer cumulative length of stay and higher cumulative cost.
PMID: 27401949 [PubMed - as supplied by publisher]