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.

Impella® Device — Indication & Safety Information

INDICATIONS FOR USE

Protected PCI

The Impella 2.5® and Impella CP® Systems are temporary (≤ 6 hours) ventricular support devices indicated for use during high-risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease, when a heart team, including a cardiac surgeon, has determined high-risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 and Impella CP Systems in these patients may prevent hemodynamic instability, which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.

Cardiogenic Shock

The Impella 2.5®, Impella CP®, Impella 5.0®, and Impella LD® Catheters, in conjunction with the Automated Impella Controller (collectively, “Impella® System Therapy”), are temporary ventricular support devices intended for short term use (≤ 4 days for the Impella 2.5 and Impella CP, and ≤ 6 days for the Impella 5.0, and Impella LD) and indicated for the treatment of ongoing cardiogenic shock that occurs immediately (< 48 hours) following acute myocardial infarction or open heart surgery or in the setting of cardiomyopathy, including peripartum cardiomyopathy, or myocarditis as a result of isolated left ventricular failure that is not responsive to optimal medical management and conventional treatment measures (including volume loading and use of pressors and inotropes, with or without IABP). The intent of Impella System Therapy is to reduce ventricular work and to provide the circulatory support necessary to allow heart recovery and early assessment of residual myocardial function.

Important Risk Information for Impella devices

CONTRAINDICATIONS

The Impella 2.5, Impella CP, Impella 5.0 and Impella LD are contraindicated for use with patients experiencing any of the following conditions: Mural thrombus in the left ventricle; Presence of a mechanical aortic valve or heart constrictive device; Aortic valve stenosis/calcification (equivalent to an orifice area of 0.6 cm2 or less); Moderate to severe aortic insufficiency (echocardiographic assessment graded as ≥ +2); Severe peripheral arterial disease precluding placement of the Impella System; Significant right heart failure*; Combined cardiorespiratory failure*; Presence of an Atrial or Ventricular Septal Defect (including post-infarct VSD)*; Left ventricular rupture*; Cardiac tamponade*

* This condition is a contraindication for the cardiogenic shock indication only.

POTENTIAL ADVERSE EVENTS

Acute renal dysfunction, Aortic valve injury, Bleeding, Cardiogenic shock, Cerebral vascular accident/Stroke, Death, Hemolysis, Limb ischemia, Myocardial infarction, Renal failure, Thrombocytopenia and Vascular injury

In addition to the risks above, there are other WARNINGS and PRECAUTIONS associated with Impella devices. Visit http://www.abiomed.com/important-safety-information to learn more.

Right-Side Support – Indication & Safety Info.

INDICATIONS FOR USE

The Impella RP® System is indicated for providing temporary right ventricular support for up to 14 days in patients with a body surface area ≥1.5 m2, who develop acute right heart failure or decompensation following left ventricular assist device implantation, myocardial infarction, heart transplant, or open-heart surgery.

Important Risk Information for Impella RP

CONTRAINDICATIONS

The Impella RP System is contraindicated for patients with the following conditions: Disorders of the pulmonary artery wall that would preclude placement or correct positioning of the Impella RP device. Mechanical valves, severe valvular stenosis or valvular regurgitation of the tricuspid or pulmonary valve. Mural thrombus of the right atrium or vena cava. Anatomic conditions precluding insertion of the pump. Presence of a vena cava filter or caval interruption device, unless there is clear access from the femoral vein to the right atrium that is large enough to accommodate a 22 Fr catheter.

POTENTIAL ADVERSE EVENTS

The potential adverse effects (eg, complications) associated with the use of the Impella RP System: Arrhythmia, Atrial fibrillation, Bleeding, Cardiac tamponade, Cardiogenic shock, Death, Device malfunction, Hemolysis, Hepatic failure, Insertion site infection, Perforation, Phlegmasia cerulea dolens (a severe form of deep venous thrombosis), Pulmonary valve insufficiency, Respiratory dysfunction, Sepsis, Thrombocytopenia, Thrombotic vascular (non-central nervous system) complication, Tricuspid valve injury, Vascular injury, Venous thrombosis, Ventricular fibrillation and/or tachycardia.

In addition to the risks above, there are other WARNINGS and PRECAUTIONS associated with Impella RP®. Visit http://www.abiomed.com/impella/impella-rp to learn more.

General Indication and Safety Information

To learn more about the Impella platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: www.protectedpci.com/indications-use-safety-information/

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