All-Cause Heart Failure Rehospitalization outcomes

Long-Term Outcomes of 30-Day All-Cause Heart Failure Rehospitalization

January 18, 2017

Key Takeaways

  • Heart failure rehospitalization is common among patients aged ≥65 years and represents a serious threat to both health- and economic-related outcomes.
  • Patients with heart failure who were readmitted within 30 days of initial hospitalization experienced greater mortality, longer length of stay, and higher care costs than non-readmitted patients.

Outcomes Associated with Readmitted HF Patients

Approximately 1 million Medicare beneficiaries with HF are hospitalized each year, and around 1 in 4 are rehospitalized within 30 days of discharge. A study from The American Journal of Medicine showed that 30-day all-cause rehospitalization resulted in significantly higher mortality for HF patients compared with those who weren’t readmitted.1

This study examined a registry of hospitalized HF patients, The Alabama Heart Failure Project, for adverse outcomes associated with all-cause, 30-day readmission. Specifically, researchers looked at the all-cause mortality associated with both 30- and 90-day readmission for HF. Additionally, researchers compared total costs of care between readmitted and non-readmitted patients.

Propensity scores were used for all-cause, 30-day readmission to balance baseline characteristics among HF patients with and without readmission. According to the researchers’ findings, within 2 to 12 months of initial HF hospitalization, mortality occurred in 41% of matched patients who had been readmitted within 30 days vs 27% of those who hadn’t been readmitted. Also, readmitted patients had higher cumulative readmissions and longer lengths of stay during a follow-up of 8.7 years. Costs were also significantly higher in this follow-up timeframe: $129,175 for readmitted vs $114,787 for non-readmitted HF patients.

Figure 1. All-Cause Mortalitya
all-cause mortality table
aData from Arundel C, Lam PH, Khosla R1

The baseline comorbidities associated with readmitted HF patients are likely contributing factors associated with rehospitalization. For example, many of the patients in this study who were readmitted within 30 days of initial hospital discharge also had:

  • Coronary artery disease (CAD)
  • Diabetes mellitus
  • Chronic kidney disease
  • Cancer
  • Pneumonia
  • Chronic obstructive lung disease

In conclusion, researchers determined that 30-day all-cause readmission is associated with a higher mortality risk during the first 12 months following readmission discharge. Analysis of 90-day all-cause readmission discovered similar findings.

How Do We Improve Outcomes in a Value-Based Care Model?

The higher prevalence of patient comorbidities, such as CAD and pneumonia, may partly explain the higher mortality in readmitted patients. Improving care for coexisting conditions and communicating to patients the importance of self-care may help reduce poor HF outcomes following readmission, thereby lowering healthcare costs and refining hospital performance as it relates to value-based care.

References:

  1. Arundel C, Lam PH, Khosla R. Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure. Am J Med. 2016;129(11):1178-1184.

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