Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure

Cherinne Arundel, Phillip H. Lam, Rahul Khosla, Marc R. Blackman, Gregg C. Fonarow, Charity Morgan, Qing Zeng, Ross D. Fletcher, Javed Butler, Wen Chih Wu, Prakash Deedwania, Thomas E. Love, Michel White, Wilbert S. Aronow, Stefan D. Anker, Richard M. Allman, Ali Ahmed

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure. Methods Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 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 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, $38,972 vs $34,025; P =.001) during 8.7 years of follow-up. Conclusions Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost.

Original languageEnglish (US)
Pages (from-to)1178-1184
Number of pages7
JournalAmerican Journal of Medicine
Volume129
Issue number11
DOIs
StatePublished - Nov 2016

Keywords

  • 30-Day all-cause readmission
  • All-cause mortality
  • Cost
  • Heart failure
  • Medicare beneficiaries

ASJC Scopus subject areas

  • General Medicine

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