Current trends in heart failure readmission rates: analysis of Medicare data

Abstract

Background: Despite advances in optimal pharmacologic therapy, patients with heart failure (HF) continue to have significant rehospitalization rates.

Hypothesis: We sought to provide current estimates on rates of readmission for Medicare patients with HF, and identify factors associated with an increased chance of readmission.

Methods: We used Medicare data from the 5% sample Standard Analytical File Limited Data Set for the years 2002 through 2004 to calculate readmission rates for HF. Clinical factors associated with readmission rates were identified using multivariate logistic regression.

Results: We identified 28,919 patients accounting for 38,849 HF hospitalizations in the 5% sample for 2003. These numbers project to an estimated 578,380 patients with 776,980 HF hospitalizations. In-hospital mortality was 4.4% with an average length of stay of 5.5 +/- 5.4 d. In the 6-9 mo following the initial HF admission, 60% of patients had 1 or more readmissions for any cause. Heart failure accounted for 28% of all readmissions. Factors associated with readmission for HF after the initial HF hospitalization included age < 65 y, geographic location, previous hospitalization, length of stay of initial HF hospitalization > 7 d, not receiving a cardiac device implant at the time of initial HF hospitalization, and history of comorbidities including diabetes, myocardial infarction, peripheral vascular disease, and stroke.

Conclusions: Medicare patients with HF continue to have significant morbidity and one of the highest in-hospital mortality rates of any HF patient population. Factors associated with worse outcomes after an initial HF hospitalization can be used to identify patients who require aggressive therapy and follow-up.