Association of 30 Day All Cause Readmission with Long Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.
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.
The American journal of medicine