Hospital readmission often attributable to different condition in older patients

Hospital readmissions were common and often triggered by a different condition among Medicare patients within the 30 days after initial hospitalization for HF, MI or pneumonia, according to study data published in JAMA.

“In the great majority of cases, readmission was for a medical condition that was different from the cause of initial hospitalization,” Kumar Dharmarajan, MD, MBA, of Columbia University Medical Center in New York, told Cardiology Today. “For example, for patients hospitalized with a heart attack, only one in 10 rehospitalizations were for a second heart attack. Ninety percent of patients were being readmitted with different conditions.”

Kumar Dharmarajan

Dharmarajan cited the frequency of hospital readmissions as a cause for concern. “Many of these rehospitalizations may be preventable and are therefore unnecessarily exposing older patients to potential harms of hospitalization, including infection, medical errors, sleep deprivation and immobility.”

The researchers examined Medicare fee-for-service claims data from 2007 to 2009 for diagnoses and timing among Medicare beneficiaries readmitted within 30 days after being hospitalized for HF, MI or pneumonia, the conditions responsible for nearly 15% of admissions in this patient population.

The researchers identified 329,308 30-day readmissions (24.8%) after 1,330,157 hospitalizations for HF, 108,992 30-day readmissions (19.9%) after 548,834 hospitalizations for acute MI and 214,239 30-day readmissions (18.3%) after 1,168,624 hospitalizations for pneumonia. In patients initially hospitalized for HF, acute MI and pneumonia, 35.2%, 10% and 22.4% were readmitted for the same condition, respectively.

“We were struck that this signal of generalized risk to a variety of conditions was present regardless of how we looked at the data,” Dharmarajan said. “It did not matter whether a patient was younger or older, male or female, or black, white, or of another race.”

Most readmissions happened during the first 15 days after hospitalization, with 61% of readmissions in the HF cohort, 67.6% in the acute MI cohort and 62.6% in the pneumonia cohort occurring within 15 days. Results indicated that median time to readmission was 12 days for those initially hospitalized for HF, 10 days for those initially hospitalized with acute MI and 12 days for patients initially hospitalized for pneumonia.

Upon leaving the hospital, there may be a “transient period of generalized risk,” Dharmarajan said. “Patients need to know they are at risk for rehospitalization from a wide variety of medical conditions.” – by Deb Dellapena

For more information:

Dharmarajan K. JAMA. 2013;309:355-363.

Disclosure: Dharmarajan received grant funding from the NHLBI.